April 30, 2016

CPT 2017 Anticipated Code Changes

A number of new codes and guideline revisions will be implemented for 2017.  As in past years, new codes have been created as a result of bundling mandates from the AMA’s Relativity Assessment Workgroup (RAW) for the purpose of identifying potentially misvalued services.  Code pairs identified as being performed together 75 percent or more of the time and, therefore, referred to the CPT Editorial Panel for bundling in 2017 include dialysis circuit intervention and open and percutaneous transluminal angioplasty (PTA) procedures.

New codes also will be introduced to describe procedures that are currently not described within the CPT code set, such as cryoablation of phantom limb pain.  In addition, a number of Category III codes will be extended, as they are not yet ready for Category I status.
The ACR urges its members to review and consider how the bundled and new code changes may impact their practices. 

Diagnostic Radiology

Fluoroscopy [77002, 77003 revisions]

The Centers for Medicare and Medicaid Services (CMS) reviewed the list of proposed global period assignments and believed that fluoroscopic guidance codes 77002 (for needle placement (eg, biopsy, aspiration, injection, localization device)) and 77003 (for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid))  should be assigned a ZZZ global value [Code related to another service and is always included in the global period of the other service]. While these codes have been classified as stand-alone XXX codes [Global concept does not apply], the ACR believes that the 77002 and 77003 vignettes and the CPT codebook parentheticals are consistent with an add-on code, as has been established for 77001 (Fluoroscopic guidance for central venous access device placement, replacement…[List separately in addition to code for primary procedure]). Therefore, the global periods for 77002 and 77003 are proposed for revision as add-on codes with a global value of ZZZ.

Mammography + Computer-Aided Detection

New codes are proposed that bundle computer-aided-detection (CAD) with mammography.  The current CAD and mammography codes 77051, 77052, 77055, 77056, and 77057 are proposed for deletion in 2017.  It is anticipated that the HCPCS Level II G codes G0202, G0204 and G0206 will be deleted as well.

Ultrasound - screening study for abdominal aortic aneurysm (AAA)   

Look for a new CPT Category I code to replace Category III code G0389, Ultrasound B-scan and/or real time with image documentation; for abdominal aortic aneurysm (AAA) screening, which is  proposed for deletion.

Interventional Radiology

Dialysis Circuit Access 

The 2017 proposed changes include the creation of new bundled codes to report dialysis circuit angiography, angioplasty, stent placement, thrombectomy and embolization to address the work related to dialysis circuit diagnosis and interventions.  Codes 35471, 35472, 35475, 35476, 36147, 36148, 36870, and 75791 are proposed for deletion.

The Joint CPT/RUC Workgroup identified codes 35475, 35476, 36147, 36148, 36870, 37236, 37238, 75791, 75962, and 75968 as being frequently reported together in various combinations. Some of these revisions were addressed previously.   

Open and Percutaneous Transluminal Angioplasty PTA 

Proposed for deletion are percutaneous transluminal balloon angioplasty codes 35471, 35472, 35475, 35476, as well as open transluminal balloon angioplasty codes 35450, 35452, 35458, 35460 and their related radiologic imaging services codes 75962, 75964, 75966, 75968, 75978. New codes will be created to capture all current uses of the codes marked for deletion.

Epidural Injections  

Proposed are revision, deletion and renumbering of injection codes 62310, 62311, 62318, 62319 that exclude imaging, revision of fluoroscopic guidance instructions related to these injections, and addition of new codes to bundle imaging guidance.

Mechanochemical (MOCA) Vein Ablation 
New codes are proposed for the reporting of non-tumescent, mechanochemical treatment of extremity vein incompetence and revision of current codes 36476 and 37479 to describe the additional veins treated. 

Category III Codes

New Category III Codes 

New Category III codes will be created to describe percutaneous cryoablation of phantom limb pain and tactile breast imaging by computer-aided sensors for use in the primary care setting as augmentation of the clinical breast exam.  Category III codes allow for more appropriate documentation and tracking of the use of these technologies.

Deletion of Category III Codes

The following Category III codes are marked to be retired in 2017:

Stereotactic placement of infusion catheter(s) in the brain for delivery of therapeutic agent(s), including computerized stereotactic planning and burr hole(s)
Percutaneous or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; for trial, including removal at the conclusion of trial period
permanent, with implantation of a pulse generator
Revision or removal of pulse generator or electrodes, including imaging guidance, when performed, including addition of new electrodes, when performed
Electronic analysis of implanted peripheral subcutaneous field stimulation pulse generator, with reprogramming when performed
Near-infrared spectroscopy studies of lower extremity wounds (eg, for oxyhemoglobin
Near-infrared guidance for vascular access requiring realtime digital visualization of subcutaneous vasculature for evaluation of potential access sites and vessel patency

Category III Codes Extended

A number of radiology Category III codes, currently marked to be retired in 2017, are proposed to be extended until the procedures/services have met the criteria for Category I status.  The radiology codes to be extended include:

0159T Computer-aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI (List separately in addition to code for primary procedure)
(Computer-aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed concurrent with primary interpretation (List separately in addition to code for primary procedure)
0175T (Computer-aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed remote from primary interpretation)
(Percutaneous transcatheter closure of the left atrial appendage with implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, radiological supervision and interpretation)

This summer the Economics & Health Policy eNews  Economics & Health Policy eNews
section of the ACR website will post an impact analysis of the 2017 code changes to help radiology and radiation oncology practices prepare for the 2017 changes.

The September/October 2016 issue of the ACR Radiology Coding Source will include a list of the new 2017 codes and descriptors pertinent to radiology.

In August, the AMA will provide an early release of a downloadable version of the CPT® 2017 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.