Radiology Coding Alert

Don't get lost among these drastic guidance code changes

Prepare to adjust your thinking -- 77xxx codes aren't just for radiation oncology anymore. CPT 2007 adds radiologic guidance, mammography, and bone and joint studies to this range of codes. Here's what you need to know.

1. Mark Up Your Mammogram Code Lists  

CPT 2007 gives you new codes for breast imaging services, including screening and diagnostic mammograms, CAD, and breast MRI. You must begin using the new codes for dates of service Jan. 1 and later or risk getting denials.

See "Move Those 2006 Mammogram Codes Off Your Job Aids" in this isuue for a crosswalk to many of these new codes.

2. Toss Out Your Guidance Code Cheat Sheets

Some of the codes you used daily in 2006, such as fluoro codes 75998, 76003 and 76005, now have new numbers.

Why? "Radiologic Guidance" has a new home: 77001-77032. CPT 2007 organizes the codes by fluoroscopic, computed tomography, magnetic resonance, and other guidance methods. 

So if you're coding guidance, don't make the mistake of entering the number you memorized in 2006. You need to verify the proper code number.

Example: CPT 2007 changes the codes for computed tomography and magnetic resonance needle-placement guidance, which represent two ways of accomplishing needle placement that you typically used to do under fluoroscopic guidance, says Susan Vogelberger, owner and president of Healthcare Consulting & Coding Education in Boardman, Ohio.

2006                     2007                           Descriptor
76360                  77012                         Computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), RS&I
76393                  77021                         Magnetic resonance guidance for needle placement (e.g., for biopsy,needle aspiration, injection, or placement of localization device), RS&I.

Tip: Appendix M of the AMA's CPT 2007 Professional Edition crosswalks deleted 2006 codes to the new 2007 codes.

3. Add Noncoronary to 71275

To correct the problem of coders reporting coronary artery CTAs with chest CTA code 71275, CPT 2007 added the word "noncoronary" to the descriptor: Computed tomographic angiography, chest (noncoronary), without contrast material(s), followed by contrast material(s) and further sections, including image postprocessing.

A new note advises you to report Category III codes 0146T-0149T for coronary artery CTAs.

Don't miss: Another new note under 71250-71270 (Computed tomography, thorax ...) instructs you to look to 0144T-0151T for cardiac CTA, instead of using the thorax CT codes.

4. Take Time to Read New Guidelines

Don't miss these two additions to the Radiology Guidelines listed before the 7xxxx code range:

• Two new functional MRI codes (70554-70555) have subsection-specific notes. If you flip to that subsection, you'll see the added instructions explain that "functional MRI involves identification and mapping of stimulation of brain function."

The instructions also explain that if a technician, non-physician, or nonpsychologist administers the neurofunctional tests, report 70554 (Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psycholo-gist administration).
 
But if a physician or psychologist administers the tests, report 70555 (... requiring physician or psychologist administration of entire neurofunctional testing).

• CPT 2007 defines "results" (service's technical component), "testing" (leads to results, which lead to interpretation), and "reports" ("work product of the interpretation of numerous test results").

5. Update Your UFE Coding

If you're performing uterine fibroid embolization (UFE), check out new code 37210 (Uterine fibroid embolization [UFE, embolization of the uterine arteries to treat uterine fibroids, leiomyomata], percutaneousapproach inclusive of vascular access, vessel selection, embolization, and all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the procedure).
 
Pay attention: This code includes all vascular access, vessel selection, the injection of the material, intra-procedure mapping, and all radiological supervision and interpretation, including image guidance, needed to complete the procedure, says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M.

6. Be Wary of B-Scans

CPT 2007 changes several ultrasound code descriptors to more accurately describe the procedures, removing the term "B-scan":

• Head and neck: 76506, 76536

• Chest: 76604, 76645

• Abdomen and retroperitoneum: 76700, 76770

• Pelvis: 76856

• Extremities: 76880

7. Crack Down on Kidney Imaging Mistakes

Look in the nuclear medicine section, and you'll see revised descriptors for many kidney imaging codes.

Now 78700-78710 all begin with the phrase "kidney imaging morphology." While you'll still have 78701 (... with vascular flow), CPT 2007 deletes 78704 (... with function study ...) and instructs you instead to look to 78707-78709 (... with vascular flow and function ...).

CPT 2007 also deletes 78715 (Kidney vascular flow only) and points you to 78701-78709 instead.

Watch for: Code +78730 (Urinary bladder residual study) is now an add-on code, which means you should only use it in conjunction with 78740 (Ureteral reflex study [radiopharmaceutical voiding cystogram]).

Note: You won't find all the changes in your CPT 2007 manual. Next month we'll cover the new category III chest x-ray CAD codes you won't find in your book. They go into effect Jan. 1, so take a sneak peek at www.ama-assn.org/ama1/pub/upload/mm/362/cat3codes.pdf