April 30, 2014

ACR Radiology Coding Source™ March-April 2014

CPT 2015 Anticipated Code Changes
A number of new radiology and radiation oncology codes will be created in 2015. A total of 22 of the 35 new codes are the result of bundling requests from the AMA’s Relativity Assessment Workgroup (RAW). The purpose of the RAW is to identify potentially misvalued services. The current screens used by the RAW are: codes frequently performed together, fastest growing, CMS/Other time source and services previously flagged as new technology.
For 2015, there were radiology and radiation oncology code pairs identified as being performed together 75 percent or more of the time and, therefore, considered by the CPT Editorial Panel for bundling in 2015. The procedure codes identified as inherently performed together include: dual-energy X-ray absorptiometry, myelography, vertebroplasty, and isodose calculation and planning.
Breast ultrasound was captured in the Harvard-based codes with utilization greater than 500,000 screen. 
Radiology practices are advised to review how the following procedures are coded currently and to anticipate how the bundled and new code changes will impact their practices. 
Diagnostic Radiology
Breast Tomosynthesis
The ACR in conjunction with the American Roentgen Ray Society and Radiological Society of North America requested the establishment of three new Category I codes to describe diagnostic and screening digital breast tomosynthesis procedures. The current mammography codes do not include the added physician work or practice expense involved in digital breast tomosynthesis and, therefore, new codes were needed to describe these additional resources.
Breast Ultrasound
Two new codes were requested to describe both complete and limited breast ultrasound procedures. The current breast ultrasound code 76645 is proposed for deletion. Code 76645, Ultrasound, breast(s) (unilateral or bilateral), real time with image documentation was identified by the RAW screen of codes with a CMS/Other time source and Medicare utilization of 500,000 or more.
Dual-Energy X-ray Absorptiometry (DXA)
The dual-energy x-ray absorptiometry bone density study and vertebral fracture assessment codes (77080 and 77082) were identified as codes reported together 75 percent or more of the time. The RAW requested that a bundled coding solution be pursued for this family of codes. The deletion of code 77082 and establishment of two new codes to describe DXA and vertebral fracture assessment were requested for 2015.
Interventional Radiology
Cryoablation for Bone and Liver Tumors
As there is substantial clinical experience and published clinical trial data documenting the clinical benefits of cryosurgical ablation of bone and liver tumors, two new CPT codes to describe percutaneous cryosurgical ablation of bone and liver tumors were proposed for 2015. Currently, these procedures are reported with an unlisted code.
The myelography lumbar injection code 62284 and imaging guidance codes 72240, 72265 and 72270 for the professional component were identified by the RAW as codes reported together 75 percent or more of the time. Therefore, the RAW requested the specialty societies bundle these codes.
Four new codes were requested to bundle the injection and imaging guidance for myelography procedures. The current injection and radiologic supervision and interpretation codes for myelography will be retained as this procedure is occasionally performed by two physicians, i.e., one physician performs the contrast injection and the second physician provides the radiological supervision and interpretation.
Percutaneous vertebroplasty and vertebral augmentation CPT codes 22520, 22521, 22522, 22523, 22524 and 22525 were identified as being reported together with guidance code 72291, Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance, 75 percent or more of the time. A multispecialty society workgroup used this opportunity to meet the mandate to bundle these codes, and to also create an updated code family that aligns how CPT describes other spinal procedures. Therefore, six new codes for vertebroplasty and vertebral augmentation (kyphoplasty) with imaging guidance were requested and the current codes 22520, 22521, 22522, 22523, 22524, 22525, 72291 and 72292 are marked for deletion. The sacroplasty for vertebral augmentation Category III codes 0200T and 0201T will be revised to include imaging guidance and extended another five years.
Transcatheter Placement of Intravascular Stents
A multispecialty society request was made to establish a new code to report the transcatheter placement of an intrathoracic carotid vascular stent. Editorial revision of cervical carotid artery stent codes 37215-37216 and codes 0075T-0076T also was requested to differentiate these codes from the new code and to make them consistent with all other endovascular bundled coding.
Endoscopic Foreign Body Retrieval
Revision was recommended to the imaging instructional parenthetical notes following codes 43194, 43215, and 43247 to direct users to code 76000 for fluoroscopic guidance when performed in conjunction with endoscopic foreign body retrieval.
Cervicocerebral Arteries
Look for editorial revision to the introductory notes for the appropriate reporting of codes 36218 and 36228. Guidance will be provided to address coding uncertainties and questions that have arisen since the cervicocerebral artery codes 36221-36228 came into use in 2013.
Three new codes were proposed to describe ultrasound imaging guidance as an inclusive component of arthrocentesis, aspiration and/or injection of a joint or bursa. Fluoroscopic-guided arthrocentesis will remain component coded.
Radiation Oncology
Isodose Calculation and Planning
The teletherapy isodose planning codes 77305-77315 and brachytherapy isodose planning codes 77326-77328, which are frequently reported with basic radiation dosimetry calculation code 77300 were identified in the codes inherently performed together 75 percent of the time or greater, as the planning codes now universally require performance of dosimetry calculation as an integral part of the procedure. 
Look for 5 new bundled codes to be created to reflect the current process of care for teletherapy and brachytherapy isodose planning and the deletion of the current codes77305-77315 and 77327-77328.
Radiation Treatment Delivery
The changes for 2015 address a number of interrelated issues. Clinical practice has evolved and several issues required CPT clarification. Three new codes will be created to report radiation treatment delivery services with clarification on which codes contain the technical component, professional component or both. Fourteen current codes that describe ultrasound guidance (76950), radiation treatment delivery codes (77403, 77404, 77406, 77408, 77409, 77411, 77413, 77414, 77416, 77418, 77421), and Category III codes (0073T, 0197T) are proposed for deletion. Revision of the guidelines and radiation treatment delivery codes 77401, 77402, 77407, 77412 will also be made. 
Category III Codes
The following Category III tracking codes have been extended for another five years: 
 Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total  leiomyomata volume less than 200 cc of tissue 
 0072T total leiomyomata volume greater or equal to 200 cc of tissue respectively
 0075T Transcatheter placement of extracranial vertebral or intrathoracic carotid artery stent(s), including radiologic supervision and interpretation, percutaneous; initial vessel
 0076T each additional vessel
 0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of    a balloon or mechanical device, when used, 1 or more needles
 0201T bilateral injections, including the use of a balloon or mechanical device, when used, 2 or  more needles* 
*Codes 0200T and 0201T were revised to include imaging guidance in 2015
The following Category III code is marked for deletion:
 0126T Common carotid intima-media thickness (IMT) study.. A new Category I code will be created in 2015 to describe this procedure.
This summer the Economics & Health Policy eNews section of the ACR website will post an impact analysis of the 2015 code changes to help radiology and radiation oncology practices prepare for the 2015 changes.
The September/October 2014 issue of the ACR Radiology Coding Source will publish a listing of the new 2015 code descriptors and codes pertinent to radiology. In August, the AMA will provide an early release of a downloadable version of the CPT 2015 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, typically in November.
Note: The AMA posts a Summary of Panel Actions that is 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® code set information is timed with the release of the entire set of coding changes in the CPT publication.