Radiology Coding Alert

Radiology coders, rejoice: CPT 2004 completely revamps the catheter and line placement access codes, resulting in greater specificity and less confusion. CPT also adds new codes for mammography, brain MRIs, tumor localization, Zevalin therapy, and fluoroscopy in its 2004 edition.
 
"The biggest relief is that CPT Codes finally revised the line placement codes," says Paulette B. Stone, CPC, RCC, quality assurance specialist at Public Employees Health Program, a nonprofit health program in Utah. "The ability to report these services correctly will greatly improve the reimbursement in any interventional radiology department."
 
A sampling of the new catheter insertion and line placement codes (36555-36597) is listed in our article "The New Codes at a Glance" on page 83. To make way for the new codes, CPT 2004 deletes catheter placement codes 36488-36493 and codes 36530-36537. "We had memorized a lot of the codes that are now being deleted, so remember to look closely at CPT 2004 to select the right PICC line and tunneled catheter codes," says Kay Tracy, BS, RCC, lead coder at the Oregon Clinic's radiology department.
 
"We were accustomed to choosing codes according to patient age and between non-tunneled or tunneled lines," Tracy says. "The new codes further break down the procedures by insertion site (central or peripheral), use of subcutaneous port or pump, and use of one or two catheters/access sites."
 
The new level of specificity will require radiologists to dictate and document their services more carefully than ever so coders can select the most accurate code.

Fluoroscopy Codes Revamped

CPT 2004 includes a new fluoroscopic guidance code to use with the central line placement codes - 75998 (Fluoroscopic guidance for central venous access device placement, replacement [catheter only or complete], or removal [includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position] [list separately in addition to code for primary procedure]).
 
CPT also adds code 76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [list separately in addition to primary procedure]).
 
"These will be more explicit than the guidance codes we previously used," Tracy says. "Hopefully, the new codes will help physicians receive adequate credit for the work they do."

Get Specific With New IR Codes

CPT 2004 introduces a new bone tumor ablation code, 20982 (Ablation, bone tumor[s] [e.g., osteoid osteoma, metastasis] radiofrequency, percutaneous, including computed tomographic guidance). "This is really going to help," says Linda Thornton, CPC, billing supervisor at St. Louis University's SLUCare. "Before 20982 came along, we had to use the miscellaneous code that corresponded with the bone we were addressing, so the new code will have a big impact on our reimbursement."
 
When you receive your 2004 edition of CPT, you may think your eyes are playing tricks on you: CPT has deleted code 76490 (Ultrasound guidance for, and monitoring of, tissue ablation) and replaced it with code 76940 (Ultrasound guidance for, and monitoring of, visceral tissue ablation). Because CPT simply transposed the "49" in the old code to "94" in the new code, some radiology practices might not even notice the difference, so be sure to update your chargemasters  and superbills in 2004 to reflect the new code.

Diagnostic Codes Updated, Revised

The descriptor change for myelography code 72270 is another significant revision for 2004. This code previously referred to myelography of the entire spinal canal, so coders who only addressed two spinal regions risked accusations of "overcoding" when reporting the entire spine myelography code when only two rather than three regions were studied. Many payers, however, would not pay for two myelography codes on the same date of service, leaving practices between a rock and a hard place. The descriptor now reads, "Myelography, two or more regions [e.g., lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical], radiological supervision and interpretation."
 
"It is very good to see that they've changed this one," Thornton says. "We received unbundling denials when we charged for two areas, so this new descriptor is welcome."
 
CPT also overhauled the mammography codes, with the deletion of 76085 and the addition of two new codes:
 

76082 - Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (list separately in addition to code for primary procedure)

76083 - ... screening mammography (list separately in addition to code for primary procedure).

Nuclear Medicine Sees Some Changes

Tracy also welcomes the addition of 79403 (Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous agent) for Zevalin therapy. "In the past, we were advised to use 79400 (Radiopharmaceutical therapy, nonthyroid, nonhematologic), but the new code is more appropriate."
 
Code 79403 should apply to Bexxar therapy as well as Zevalin. In addition, the new code 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging) should help coders more specifically identify the imaging studies that are performed before the therapeutic administration.
 
Note: Although this article presents the codes and editorial changes that radiology practices will use most often, you should review CPT 2004 in its entirety to ensure that you update your superbills in 2004 to reflect new, deleted and revised CPT codes. In addition, these code changes and additions are not yet finalized. The AMA CPT Advisory Committee will meet in November to review the code changes and make its final determination on the 2004 CPT codes.