CPT 2014 Expected Code Changes

Of the proposed 31 new procedure codes for CY2014 that directly pertain to radiology, 26 codes are the result of bundling requests from the Relative Value Scale Update Committee’s (RUC) Relativity Assessment Workgroup (RAW).

Code pairs identified as being performed together 75 percent of the time or more and therefore considered by the CPT Editorial Panel for bundling in 2014, included abscess drainage, breast biopsy, embolization and intravascular stent procedures. In addition, the radiation oncology therapeutic radiology simulation-aided field setting code was captured in the Harvard-based codes with utilization greater than 30,000 screen.

Look for the Economics & Health Policy News section of the ACR website for an impact analysis of the 2014 code changes to be posted this summer. Radiology practices are advised to review how the following procedures are coded currently and to anticipate how the bundled changes will impact their practices.

Abscess Drainage
The abscess drainage codes 49021, 49041 and 49061 were identified as codes reported together with imaging guidance 75 percent or more of the time. Therefore, the RAW requested that the abscess drainage codes and guidance code 75989 be bundled. The ACR and other specialty societies submitted a code proposal to develop a more cogent structure of the percutaneous abscess drainage codes and improve this family of codes. A new code also was recommended that describes a soft-tissue fluid collection drainage by catheter using imaging guidance.

Breast Biopsy
New bundled codes will be created to describe breast biopsy procedures that include imaging guidance as well as placement of one or more localization device(s) and imaging of the specimen when performed. Codes 77031, 77032, 76098, 19103, 19290 and 19295 were caught in the 75-percent screen. New codes also will be created to report the placement of clips and other breast localization devices without biopsy or during aspiration procedures.

Embolization
Also caught in the 75-percent screen was the surgical embolization code 37204, which is billed in conjunction with the radiological supervision and interpretation (RS&I) codes 75894 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation) and 75898 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis).

New codes and introductory guidelines will be provided for reporting bundled embolization and occlusion procedures. Deletion of the existing surgical codes 37204 and 37210 was recommended, as these services would be reportable with one of the new family of embolization codes.

Intravascular Stent
The endovascular revascularization procedures were identified by the RAW during the RUC five-year review process in 2008 as potentially misvalued via a high-volume growth screen. The RAW requested codes 37205-37208 be revised at that time. However, the RAW agreed to defer review as requested by the ACR and other specialty societies because it would be difficult to describe a typical patient and a typical clinical scenario given the revision of the lower extremity revascularization codes in 2010. In April 2010, code 37205 was identified as a potentially misvalued service by the 75-percent screen. The specialty societies again were encouraged to create new codes that bundle 37205-37208 with RS&I code 75960.

Look for new codes to describe intravascular stent revascularization (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial or coronary), which will include RS&I, and angioplasty within the same vessel when performed.

Harvard-Based Codes with Utilization Greater Than 30,000
CPT code 77280, Therapeutic radiology simulation-aided field setting; simple, was captured by the Harvard valued-utilization over 30,000 screen. The RUC requested that ASTRO survey the entire family of simulation codes (77280, 77285, 77290, 77295). However, ASTRO reviewed the process of care associated with these codes and determined this family of codes should be referred to CPT for revision.

Look for three changes to occur in conjunction with radiation oncology procedures: (1) revision to the family of simulation codes; (2) creation of a new respiratory motion management simulation code; and (3) revision and reassignment of CPT code 77295.

The new simulation codes recommended address the significant changes that have taken place in the process of care for physician and staff and the nature of the equipment utilized.

An add-on code to report respiratory motion management simulation; clinical treatment planning introductory guidelines to clarify the reporting of this service; and the definitions for simple, intermediate and complex treatment planning have been revised to reflect current clinical practice.

Code 77295, Therapeutic radiology simulation-aided field setting; 3-dimensional, represents the work of physics and dosimetry planning and is incorrectly named as “simulation.” The work of 77295 is quite different from the existing and proposed revised simulation codes. Editorial revision to the descriptor and possible renumbering of 77295 as part of the restructuring of simulation codes was recommended.

Category III Codes
Cerebral perfusion analysis using computed tomography (0042T)

The ACR and the American Society of Neuroradiology requested the extension of Category III code 0042T, 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, which had been scheduled to sunset in 2014. This code extension was requested in order to continue to track the utility and increasing number of cerebral perfusion studies. CT perfusion remains a work in progress with respect to uniformity of application and integration, such as vendor specific issues, agreement on stroke protocols and dose-related concerns.

Renal Denervation
A new Category III code will be created to describe percutaneous renal denervation (PRD) from a transcatheter approach. PRD is an endovascular catheter-based procedure using radiofrequency energy to ablate the nerves in the vascular wall of the renal artery(ies), and has shown promise in treating patients with hypertension resistant to drug therapy.

Myocardial Innervation
A Category III code was requested to describe the utilization of gamma-scintigraphy in the assessment of myocardial sympathetic innervations to track and differentiate studies of infarct from flow. Currently, providers are using an unlisted procedure code, either CPT code 78499, Unlisted cardiovascular procedure, diagnostic nuclear medicine, or CPT code 78999, Unlisted miscellaneous procedure, diagnostic nuclear medicine.

The September/October 2013 issue of the ACR Radiology Coding Source will publish a listing of the new 2014 code descriptors and numbers. In addition, the AMA will provide an early release of a downloadable version of the CPT code book from the AMA Bookstore. The CMS-approved values for codes, however, will not be known until the Medicare Physician Fee Schedule Final Rule is published in the Federal Register.

Note: The AMA posts a Summary of Panel Actions that are available for public viewing. While this summary lists the code changes proposed and the actions taken by the panel, the AMA cautions that these actions are a reflection of the discussions at the most recent panel meeting. Future panel actions may impact these items. Codes are not assigned, nor exact wording finalized, until just prior to publication. Release of this more specific CPT® codeset information is timed with the release of the entire set of coding changes in the CPT publication.