Radiology Coding Alert

 Remember: The # symbol indicates a resequenced code.

Updated evaluation and management (E/M) codes may be receiving a lot of attention heading into the new year, but the 2023 CPT^® code set also features a handful of key code changes that pertain to radiology coders.

Check out the new radiology code and descriptor revisions that take effect January 1.

Understand the Ultrasound Code Updates

The Diagnostic Ultrasound section of the 2023 CPT^® code set features two key changes to the Extremities subsection that take effect January 1. Currently, codes representing diagnostic ultrasounds of the extremities include:

• 76881 (Ultrasound, complete joint (ie, joint space and peri-articular soft-tissue structures), real-time with image documentation)
• 76882 (Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation)
• 76885 (Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation))
• 76886 (… limited, static (not requiring physician or other qualified health care professional manipulation))

In the 2023 CPT^® code set, you’ll find a change to 76882’s descriptor (Note: The revision is underlined for easy reference.):

• 76882 (Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation)

Limited ultrasounds are targeted ultrasounds that providers use to evaluate a specific body area. Providers use this focused view to better diagnose and treat the patient’s condition. Code 76882 is a limited ultrasound of the patient’s joint or another extremity structure that isn’t a blood vessel. In the 2023 CPT^® code set, the AMA added “focal evaluation of” to 76882’s descriptor. “Because this is a limited ultrasound exam, the addition of ‘focal evaluation of’ further specifies the limited nature of the exam,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner of Pinnacle Enterprise Risk Consulting Services.

Learn the New Extremity Neuromuscular Ultrasound Code

The ultrasound section updates also include a new addition to the code set:

• 76883 (Ultrasound, nerve(s) and accompanying structures throughout their entire anatomic course in one extremity, comprehensive, including real-time cine imaging with image documentation, per extremity)

Starting January 1, you’ll assign 76883 to report the real-time, complete neuromuscular ultrasound of the patient’s extremity nerves and accompanying structures. This code applies to an ultrasound performed on the entire anatomic course of the patient’s extremity.

According to the January 2022 AMA RVS Update Committee (RUC) Meeting Minutes, you’ll assign 76883 when the provider examines the entire length of the nerve including:

• Examination of multiple areas for potential nerve compression
• Measure cross-sectional areas
• Assessment of echogenicity, vascularity, and mobility, which includes dynamic maneuvers (when indicated)
• Assessment for possible associated muscular denervation, as well as comparison to unaffected muscles or nerves within that extremity (as needed)

(Source: www.ama-assn.org/system/files/jan-2022-ruc-meeting-minutes.pdf)

Absorb New Acquisition Wording in Tumor Localization Codes

Starting Jan. 1, 2023, select codes in the Nuclear Medicine section of the Radiology codes are revised. (Note: Portions of the revised descriptors below have been emphasized to show the changes. Strikethroughs denote what’s being deleted from the 2022 definitions; underlines denote what’s being added for the 2023 definitions):

• 78803 (Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging)
• 78830 (… tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging)
• 78831 (… tomographic (SPECT), minimum 2 areas (eg, pelvis and knees, chest and abdomen and pelvis) or separate acquisitions (eg, lung ventilation and perfusion), single day imaging, or single area or acquisition imaging over 2 or more days)
• 78832 (… tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, minimum 2 areas (eg, pelvis and knees, chest and abdomen and pelvis) or separate acquisitions (eg, lung ventilation and perfusion), single day imaging, or single area or acquisition imaging over 2 or more days)

The codes listed above describe procedures where the provider uses a gamma-emitting radioactive tracer to locate and diagnose a tumor, inflammatory process, or radiopharmaceutical agent distribution. If the provider uses single-photon emission computerized tomography (SPECT) scanning to complete the procedure, you’ll assign 78803 or 78831. However, if the provider performs the procedure using a SPECT along with computed tomography (SPECT-CT) scan, you’ll assign 78830 or 78832. Using both SPECT and CT imaging lets the provider study how the body functions and how each body structure looks, so the provider can determine any abnormalities in the patient’s body.

The term “or acquisition” has been added to the descriptors for codes 78803 and 78830-78832. “The AMA added the term ‘acquisition’ to further specify the term ‘single area.’ In these codes, if a single area is targeted or the specified area is imaged in a single acquisition, these codes are still used,” Taylor says.

Symbolism: Codes 76882, 78803, and 78830-78832 all feature a blue triangle symbol next to the codes in the AMA CPT^® code set. This triangle indicates the codes have been revised. Codes 78830-78832 also feature a # symbol, which indicates the codes have been resequenced. This means when the codes were added to the Nuclear Medicine code family, the next code numbers in the sequence weren’t available, so the codes are not in order.