Radiology Coding Alert

The fourth quarter of any given year is full of policy changes affecting radiology coders. In addition to announcements of new procedure codes and CCI edits, changes to level II codes and modifications to the physician Fee Schedule will also have an impact on radiologists in the coming year.

Medicare Level II Codes

Although the Health Care Financing Administration (HCFA) has announced hundreds of new level II codes for 2001, only a few will affect radiology practices. In response to the establishment of the Hospital Outpatient Prospective Payment System (HOPPS) in August, HCFA introduced a new category of level II C codes. These codes are to be used exclusively for services paid under HOPPS and not with other Medicare payment systems, according to HCFA.

Among the changes to level II codes, two are significant for radiology practices:

The deletion of G0159 (percutaneous thrombectomy and/or revision, arteriovenous fistula, autogenous or nonautogenous dialysis graft). This temporary code is being replaced by 36870 (thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft [includes mechanical thrombus extraction and intra-graft thrombolysis]). According to Gary Dorfman, MD, FACR, FSCVIR, past president of the Society of Cardiovascular and Interventional Radiology and president of Health Care Value Systems in North Kingstown, Pa., which provides practice management services and revenue optimization techniques through coding and billing support, the new code describes all percutaneous methods of opening thrombosed dialysis shunts, including mechanical thrombectomy, Fogarty balloon and administration of a thrombolytic agent.

The addition of HCPCS Code S8080 (scintimammography). Scintimammography is a breast imaging technique that uses a radionucleotide for the detection of cancer, according to Rebecca A. Zuurbier, MD, director of the Betty Lou Ourisman Breast Health Center at Georgetown University Hospitals Lombardi Cancer Center in Washington, D.C. The patient is injected with a radiotracer (usually technetium TC 99m Sestamibi) attached to a substance that only breast cancer cells absorb. These studies were previously reported using 78800 (radiopharmaceutical localization of tumor; limited area), but the addition of S8080 formalizes recognition of scintimammography as a proven diagnostic tool.

Other additions found in 2001 level II codes are A9510 (technetium TC 99m disofenin) and A9700 (echocardiography contrast). A9700 replaces Q0188, also defined as echocardiography contrast, which was issued as a temporary code last year.

Physician Fee Schedule for 2001

HCFA announced on Nov. 1 that new Medicare payment rates to physicians will increase an average of 4.5 percent overall in 2001. Radiologists will realize a slightly lower increase of 2 percent, with radiation oncologists earning 3 percent above that figure.

The increases are a result of the implementation of a new payment system based on resources in providing care, as opposed to physicians historical charges. 2001 is the third year of a four-year phase-in of the new system. Seventy-five percent of physician fees will be based on the new system, while 25 percent will be based on historical charges. Payments for 2002 will be based entirely on the new system.