Radiology Coding Alert

Although Radiology Coder have good reason to celebrate many of the new CPT Changes in 2003, some of the coding clarity may come with a price. Voluminous new codes corral lots of individual components under a single heading, raising concerns about whether RVUs will reflect the level of effort required by these procedures. Of particular interest are codes relating to insertion and revision of transvenous intrahepatic portosystemic shunts (TIPS).

TIPS for the New 'Wal-Mart' Codes

"Sometimes you have to be careful what you ask for," says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc., an Atlanta-based firm. For example, you'll find several codes that combine multiple component procedures under a single descriptor, as with the new TIPS codes:

Because they include everything from venous access, hepatic and portal vein catheterization, portography, track formation and stent placement to imaging guidance and documentation, Parman likens the new TIPS codes to "one-stop shopping."

While comprehensive codes have the benefit of clarity, the RVUs will be critical, Parman says. The risk with "Wal-Mart codes," where you can get everything in one place, is that reimbursement may not reflect the level of clinical effort.

Balloon Occlusion Also Bunched

In another case of one-stop shopping, the new temporary balloon occlusion code at least clarifies the old competing theories about how to code arterial occlusions:

"We really needed 61623 because no one knew whether to use a modifier -52 for reduced service or a modifier -22 (Unusual procedural services) for a more complicated service," Parman says. This new code is perfectly clear, but it bundles virtually everything, including the concomitant neurological monitoring, all angiography, as well as checking the procedure afterwards. Yet-to-be-disclosed RVUs will be critical here, too.

Gotta Love Those Pericatheter Codes

There's no quibbling about long-needed codes for the removal of pericatheter obstructive material:

"I think these are wonderful," Parman says. Prior to CPT 2003, there was wide dissent among coders and radiologists about whether to use a code for retrieval of foreign body. Some doctors had been loathe to employ the foreign-body codes which carried high RVUs because a fibrin sheath is, technically speaking, a natural outcome of catheterization, not a foreign body. Now that we have this fibrin response stripping option, Parman says, everyone will know exactly which code to use.

The modifications for all new CPT codes will take effect Jan. 1, 2003, for Medicare, although other carriers may take additional time to adopt them. Radiology practices and coders should work closely with other payers to zero in on exactly when to begin reporting the new codes.