Efficient reporting and proper reimbursement for radiology services depend on understanding the CPT codes for this specialty. That’s one of the main reasons why it makes sense for radiology practices to outsource medical billing and coding to an experienced service provider.
The coding changes impacting radiology in 2021 are the result of bundling mandates from the American Medical Association’s (AMA) Relativity Assessment Workgroup (RAW) with the aim of identifying what it considers potentially “misvalued” services. While the main coding updates are for Evaluation and Management (E/M) services, there are also new codes for diagnostic imaging and interventional radiology. The American Medical Association (AMA) considers the 2021 updates “as the first major overhaul in more than 25 years to the codes and guidelines for office and other outpatient evaluation and management (E/M) services”.
The revised codes allow physicians to select the appropriate code based on:
- The level of medical decision making (MDM) or
- The total time performing the service on the day of the encounter
CT Lung Cancer Screening
- A new lung cancer screening code representing CT of the thorax will be available to replace G0297, Low dose CT scan (LDCT) for lung cancer screening:
71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material
- CPT codes 71250-71270 revised: The existing codes for CT of the thorax (71250-71270) have been revised as “diagnostic”. Codes 71250-71270 designate CT of the thorax with or without contrast materials. These scans may be ordered to evaluate any abnormal or suspected areas of the lungs, pleura, chest wall, mediastinum or any other lung abnormalities. The word “diagnostic” has been included in revised CPT codes 71250, 71260 and 71270 in order to differentiate the screening CT scan of the thorax from the diagnostic scans of the same area. Codes 71250-71270 are no longer relevant to report lung cancer screening.
Other Revised Codes
Code 74425 to report diagnostic radiology procedures of the urinary tract has been revised to remove the specific exams so that the CPT can be used to report any antegrade urography service.
Code 76513 which describes diagnostic ophthalmic ultrasound examination using immersion water bath B-scan or high resolution biomicroscopy, has been revised to include “unilateral or bilateral” to the existing description.
Radiation Dose Exposure
- There is a new code 76145 for evaluation of radiation exposure that exceeds institutional review threshold
Breast CT
Category III codes represent codes for new and emerging technology, services, and procedures. New Category III codes for CT of the breast have been developed with designations for unilateral/bilateral as well as standard contrast options.
0633T Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast material
0634T Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s)
0635T Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast, followed by contrast material(s)
0636T Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast material(s)
0637T Computed tomography, breast, including 3D rendering, when performed, bilateral; with contrast material(s)
0638T Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast, followed by contrast material(s)
CT Lung Biopsy
Code 32405 – Under Excision/Resection Procedures of the Lungs and Pleura will be deleted. There is a new code for lung biopsy that bundles imaging guidance:
32408 Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed
Prostate Ablation
A new Category I code has been introduced for prostate ablation with ultrasound guidance:
55880 Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance
Spinal Procedures
New Category III codes have been developed for percutaneous injection into the lumbar intervertebral disc.
0627T Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; first level
0628T Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; each additional level (List separately in addition to code for primary procedure)
0629T Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar; each additional level (List separately in addition to code for primary procedure)
0630T Percutaneous transcatheter ultrasound ablation of nerves innervating the pulmonary arteries, including right heart catheterization, pulmonary artery angiography, and all imaging guidance
However, MedPageToday reported that while providers support the CPT coding revisions and revaluations of office and outpatient evaluation and management (E/M) services recommended by the AMA/Specialty Society RVS Update Committee (RUC), the Medicare payment changes due to budget neutrality changes required by law has raised a lot of concern. Radiology medical billing and coding services provided by an experienced physician billing company are all the more important to submit accurate claims and maximize revenue.