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Radiology Coding Alert

Get Ready for New Endovenous Ablation Therapy and PET/CT Codes

Published on Sat Oct 09, 2004

Some of your prayers for more radiology codes could be answered soon

The clock is ticking toward the release of new CPT Codes for 2005 - and we've got the inside scoop. Check out these possible new CPT codes and these confirmed Category III codes released by the American Medical Association, both effective Jan. 1.

Prepare for (Provisional) Codes

Experts predict four new codes beginning with the descriptor "Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous ..." Code 36475 will cover radiofrequency for the first vein treated, and add-on CPT 36476 will cover subsequent veins in the same extremity treated through separate access sites. Similarly, code 36478 will cover laser treatment of the first vein, while add-on code 36479 will include subsequent veins in the same extremity treated through separate access sites.

The only code for this service now is an unlisted-procedure code, so the new codes will allow for more accuracy, says Dawn Hopkins, senior manager for reimbursement with the Society of Interventional Radiology.

You may be able to add vertebral fracture assessment to your list of DEXA codes with 76077 (Dual energy x-ray absorptiometry [DEXA], bone density study, one or more sites; vertebral fracture assessment).

If you work with ophthalmic ultrasound, check out 76510 (Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter). B-scan ultrasound produces a two-dimensional map of the ocular and orbital tissues, while the quantitative A-scan reveals the distance between structures within the eye and orbit, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla.

Don't miss these possible new PET tumor-imaging codes:

  • 78811 - Tumor imaging, positron emission tomography (PET); limited area (e.g., chest, head/neck)

  • 78812 - ... skull base to mid-thigh

  • 78813 - ... whole body

  • 78814 - Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; limited area (e.g., chest, head/neck)

  • 78815 - ... skull base to mid-thigh

  • 78816 - ... whole body.

    Watch out: There's a good chance people will misinterpret these codes, says Denise Merlino, CNMT, MBA, FSNMTS, the coding and reimbursement adviser to the Society of Nuclear Medicine (SNM) who staffs the SNM Coding and Reimbursement Committee.

    Merlino emphasizes that if these new codes for PET with concurrently acquired CT are published, they should not be used when a radiologist performs both a PET and a separate CT. A concurrent CT refers to a study done on specific machines that allow you to do a PET with a concurrent CT for attenuation correction, meaning a more defined PET that produces better images. This technology costs more money, and that's why it needs its own code for reimbursement, she says, especially because a lot more practices are buying these machines.

    If the AMA adopts these codes, you will be able to report the PET based on how much of the body you're scanning, which gives a more accurate idea of how much time was spent than the current G codes, which depend more on indication than the amount of effort involved.

    Pay Attention to LCDs and CPTs
     
    You need to watch out for Local Coverage Determinations for these new codes, especially for PET/CT and the new DEXA code, to make sure your local carrier accepts the medical necessity of the procedures, says Jeff Fulkerson, BA, CPC, CMC, senior certified coder for the Department of Radiology at The Emory Clinic in Atlanta. And Fulkerson stresses that you must pay attention when the codes come out, because you will have no grace period this year.

    See     www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3093.pdf for more information on the grace period. And remember, coding experts have had a sneak preview of the new CPT codes, but these new codes are provisional and subject to change, so you shouldn't consider any of them official until you receive your 2005 CPT book. Nevertheless, this early information provides a valuable first glimpse of next year's codes to help you start preparing.

    Welcome New Radiotherapy Codes

    Radiotherapy may also be getting a list of new codes, both CPT Category I and Category III. In CPT 2005, you may find 79005 (Radiopharmaceutical therapy, by oral administration), 79101 (... by intravenous administration), and 79445 (... by intra-arterial particulate administration), allowing for more specific reporting of these services.

    New temporary codes, or Category III codes, include stereotactic body radiation therapy, treatment delivery, one or more treatment areas, per day (0082T) or treatment management, per day (0083T). You won't be able to report 0082T with 77401-77416 (Radiation treatment delivery codes) or 77418 (Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams [e.g., binary, dynamic MLC], per treatment session). Don't report 0083T with codes 77427-77432 (radiation treatment management).

    See the full list of Category III codes online at
    www.ama-assn.org/ama/pub/category/3885.html.

    Contemplate Category III

    Other temporary codes include the following:

  • Transcatheter placement of extracranial vertebral or intrathoracic carotid artery stent(s), including radiologic supervision and interpretation (S&I), percutaneous; initial vessel (0075T) and each additional vessel (0076T).

    These codes replace transcatheter extracranial placement codes 0005T-0007T, which allowed you to specify with or without radiological S&I. The new codes appear to include S&I automatically, experts say. They expect the AMA to release new Category I codes for carotid stenting, which could change how you'll use 0075T and 0076T.

  • Endovascular repair of abdominal aortic aneurysm, pseudoaneurysm or dissection, abdominal  aorta involving visceral vessels (superior mesenteric, celiac or renal); using fenestrated modular bifurcated prosthesis (two docking limbs) (0078T). Or with radiological S&I (0080T).

  • Placement of visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm  involving visceral vessels, each visceral branch (0079T), or with radiological S&I (0081T).

    Don't forget: Other codes became effective July 1, 2004, like 0073T (Compensator-based beam modulation treatment delivery of inverse planned treatment using three or more high-resolution [milled or cast] compensator convergent beam modulated fields, per treatment session). This code, which can't be reported with 77401-77416 or 77418 (treatment delivery codes), is important for freestanding radiation treatment centers using this technology because many payers won't reimburse for a temporary Category III code. Unlike hospitals, freestanding centers must use the temporary code to bill for this service.

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