2003 CPT Code Update
The ACR has worked on many new codes and revisions for the Current Procedural Terminology (CPT®) manual for 2003. The following are highlights of the significant radiology and radiation oncology code changes, effective Jan. 1, 2003.
Interventional Procedures
Transvenous Intrahepatic Portosystemic Shunt(s) (TIPS)
In order to standardize and simplify coding for TIPS, two new, all-inclusive codes were developed to describe TIPS insertion (37182) and revision (37183) procedures. The imaging codes are included in the procedural code because the work of the two steps is always done together by the same physician. Prior to 2003, TIPS was commonly coded with component codes. Note that since access is not limited to the jugular and transjugular veins, the term “transvenous” is used in the code descriptor.
Mechanical Removal Fibrin Sheath/Obstructive Material from Central Venous Devices
Four codes were added to describe the mechanical or manual removal of obstructive material from central venous devices. Code 36536 identifies the mechanical removal of pericatheter obstructive material (e.g., fibrin sheath); 36537 describes the mechanical removal of intraluminal (intracatheter) obstructive material. Codes 75901 and 75902 describe the radiological supervision and interpretation (RS&I) services performed in conjunction with 36536 and 36537 respectively.
Endovascular Repair of Abdominal Aortic Aneurysm
Open repair of the femoral artery and endovascular repair of the infrarenal abdominal aorta codes (34812, 34825 and the associated RS&I code, 75953) were revised to differentiate them from the new open procedure codes. New open procedure codes, 34833 and 34834, describe the creation of iliac and brachial artery conduits to allow introduction of infrarenal aortic or iliac endovascular prosthesis.
Endovascular Repair of Iliac Aneurysm
New codes were added to report the endovascular graft replacement for repair of an iliac artery. Code 34900 represents the surgical procedure, and 75954 represents the imaging S&I.
Endovascular Thoracic Aortic Aneurysm
Eight category III codes were added to identify a new method of repairing endovascular thoracic aortic aneurysm (TAA). The initial repair of TAAs through the use of an endoprosthesis is described by code 0033T (involving coverage of left subclavian artery origin) and code 0034T (not involving coverage of left subclavian artery origin). Code 0035T identifies the initial extension placement, and 0036T identifies subsequent extensions of the endovascular repair. Code 0037T reports open arterial transposition of the subclavian artery to the carotid artery when performed in conjunction with endovascular TAA repair. Codes 0038T-0040T describe the S&I codes to be used in conjunction with the above TAA procedures.
Endovascular Temporary Balloon Occlusion
A new code, 61623, describes procedures involving temporary extracranial/intracranial endovascular balloon occlusion and concomitant neurologic testing. As noted in the descriptor, RS&I is included in 61623. The descriptor for code 61624 now reads “transcatheter permanent occlusion or embolization” to differentiate its use from the temporary endovascular balloon occlusion.
Diagnostic Radiology
Obstetrical Ultrasound
Five new codes (76801, 76802, 76811, 76812, 76817) were added and four code descriptors (76805, 76810, 76815, 76816) were revised for obstetrical ultrasound. Codes 76801 and 76802 were added to describe complete and limited studies performed during the first trimester. Codes 76811 (first fetus) and +76812 (each additional fetus) were added to describe an extensive evaluation and detailed anatomic survey for pregnancies at elevated risk for birth defects after the first trimester. As stated in the introductory notes, in addition to the elements described in codes 76805 and 76810, this extensive evaluation would include “detailed anatomic evaluation of the fetal brain/ventricles, face, heart/outflow tracts and chest anatomy, abdominal organ specific anatomy, number/ length/architecture of limbs and detailed evaluation of the umbilical cord and placenta and other fetal anatomy as clinically indicated.” Because these new codes are very specific as to anatomic evaluation, it is important that these studies be well documented. The January/ February 2003 issue of the ACR Radiology Coding Source™ will further discuss these new ultrasound changes.
CT Perfusion
A category III code, 0042T, was added to describe cerebral perfusion analysis using computed tomography. This code includes the postprocessing of parametric maps for the quantitative assessment of cerebral blood flow, cerebral blood volume and mean transit time.
Mammography
The computer-aided detection (CAD) add-on code (+76085) was revised. The word “screening” was dropped from the descriptor; in 2003 it would be appropriate to use this code to describe CAD when used in conjunction with both screening and diagnostic film-to-digital mammography.
Other Procedures
- Three new codes (76496,76497, 76498) were added to describe unlisted diagnostic or interventional procedures using fluoroscopy, CT and magnetic resonance respectively.
- The CT bone mineral density code (76070) was revised to specify the axial skeleton (e.g., hips, pelvis, spine) and 76071 was added to specify the appendicular skeleton (e.g., radius, wrist, heel) and to differentiate the axial from the appendicular (peripheral) skeleton.
- A new category III code, 0028T, was established to provide a reporting mechanism for the assessment of body fat composition using dual energy X-ray absorption (DEXA) of one or more sites.
Editorial Changes
A number of editorial changes were made to the descriptors. All descriptors containing the phrase “computed axial tomography” were revised to state “computed tomography,” a more accurate descriptor because CT can now be done as a direct acquisition imaging performed in any plane, not just the axial plane.
The use of code 74022 (complete acute abdomen series) was expanded. By replacing the term “upright PA” with “single view” chest, it now describes any single view chest performed during a complete acute abdomen series.
The descriptor for 76006 was revised to specify that this code is to describe only the manual application of stress applied during an imaging procedure. A cross-reference was also added that states the radiological interpretation of stressed images is coded separately.
Radiation Oncology
The descriptor for the brachytherapy isodose plan codes 77326 (single), 77327 (intermediate) and 77328 (complex) were revised. The word “calculation” has been replaced with the word “plan.”
For more information on category I, II and III CPT® codes refer to the November 2001 ACR Bulletin coding article (www.acr.org).
ACR members may submit questions about this article to the economics and health policy department via fax at (703) 391-1757, or can call (800) 227-5463, ext. 4584.
