Radiology practices and medical coding companies need to be ready to implement several radiology code changes and guidelines coming up in 2018. Announcing these anticipated changes, the American College of Radiology (ACR) notes that many of the new codes are outcome of bundling mandates from the AMA’s Relativity Assessment Workgroup (RAW) aimed at identifying services that may be misvalued. The code changes will impact diagnostic radiology, interventional radiology and radiation oncology.
- Chest X-ray Codes The 2016 Medicare Physician Fee Schedule (MPFS) had included chest x-rays in the list of potentially misvalued codes in pertaining to radiology. Following the Relative Value Scale Update Committee’s (RUC) directive to revise these codes, the ACR requested that the descriptor language be updated so as to increase the flexibility and accuracy for coding customized exams. The CPT code changes for chest x-rays expected in 2018 are as follows: New chest x-ray codes: 4 new codes to report chest x-ray procedures described by the number of views vs view-specific descriptors Proposed deletions: Codes 71010, 71015, 71020, 71021, 71022, 71023, 71030, 71034, and 71035
- Abdominal X-ray Codes The 2016 MPFS Notice of Proposed Rule Making, Potentially Misvalued Codes Identified through High Expenditure by Specialty Screen included abdominal x-ray codes 74000 and 74022. The following code changes are proposed with the view to improving the flexibility and accuracy for coding customized exams: New abdominal x-ray codes: 3 new codes to report abdominal x-ray procedures described by the number of views vs view-specific descriptors Proposed deletions: Codes 74000, 74010 and 74020
- Cryoablation Treatment of Pulmonary Tumors A new CPT Category I code is proposed to replace Category III code 0340T.New code: CPT Category I code Proposed deletion: Category III code 0340T, Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidanceProposed revision: Code 32998, Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s)… is to be revised to include imaging for ablation of tumor
- Endovascular Repair Infrarenal Aorta The RAW identified 3 codes used to report endovascular repair of abdominal aortic aneurysms (EVAR) and some EVAR codes for revision: New codes:
- Bundled codes
- Codes to represent adjunctive procedures that may be performed with EVAR
Proposed deletions: 34800-34806, 34825, 34826, 34900, 75952-75954, 93982, 0255T
Proposed revision: 0254T Endovascular repair of iliac artery bifurcation (e.g., aneurysm, pseudoaneurysm, arteriovenous malformation, trauma, dissection) using bifurcated endograft from the common iliac artery into both the external and internal iliac artery, including all selective and/or nonselective catheterization(s) required for device placement and all associated radiological supervision and interpretation, unilateral
- Endovenous Ablation of Incompetent Veins
New codes will be established for reporting:
- Endovenous ablation therapy of incompetent veins using a chemical adhesive.
- Injection of a non-compounded foam sclerosant for treatment of incompetent veins
Proposed revision: Injection codes 36468, 36470, and 36471 will be revised to distinguish treatment of spider veins and incompetent veins for telangiectasia and for diagnoses other than telangiectasia
- Bone Marrow Diagnostic Procedures
- New code to describe a diagnostic bone marrow procedure that bundles biopsy and aspiration into one code.
- Proposed revision: Codes 38220, Bone marrow; aspiration only and 38221, Bone marrow; biopsy, needle or trocar to be revised to specify that these are diagnostic studies.
- Brachial Retrograde Artery Introduction of Needle or Catheter
- Proposed deletion: angiography codes 36120 and 75658, as these services are more appropriately reported with other existing upper extremity angiography codes
- Proposed revision: Code 36140, Introduction of Needle or catheter, brachial retrograde artery, will be revised to describe upper or lower extremity and will become a stand-alone code
The proposed changes for radiation oncology are as follows:
- Transperineal Placement of Biodegradable Material
- New code: CPT Category I code with revised descriptor to replace Category III code 0438T, Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance
- Proposed deletion: Code 77422, High energy neutron radiation treatment delivery; single treatment area using a single port or parallel-opposed ports with no blocks or simple blocking, will be deleted due to low utilization
- Nuclear Medicine
- Proposed deletion: Due to low utilization, code 78190, Kinetics, study of platelet survival, with or without differential organ/tissue localization
- Category III Codes
- Proposed deletion: 0255T Endovascular repair of iliac artery bifurcation (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using bifurcated endoprosthesis from the common iliac artery into both the external and internal iliac artery, unilateral; radiological supervision and interpretation
(Coders will be referred to code 0254T)
- The following codes will be converted to Category I Code Status:
- 0340T Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance
- 0438T New CPT Category I code with revised descriptor to replace Category III code 0438T, Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance.
- Proposed Revisions
- 0254T Endovascular repair of iliac artery bifurcation (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using bifurcated endoprosthesis from the common iliac artery into both the external and internal iliac artery, unilateral, will be revised to bundle in all radiological supervision and interpretation.
- To Be Extended: 042T Cerebral perfusion analysis using computed tomography with contrast administration, including post-processing of parametric maps with determination of cerebral blood flow, cerebral blood volume, and mean transit time.
The complete listings of code changes are available in the AMA’s CPT 2018 code book and the ACR will post an impact analysis of the 2018 code changes on its website. Radiology and radiation oncology practices need to review the bundled and new code changes and consider how they may impact their practices. Medical coding outsourcing can help radiology and radiation oncology practices prepare for the 2018 changes.