ACR Radiology Coding Source™ Nov-Dec 2007 Q and A

Q: Does the physician have to image the spermatic cord when performing an ultrasound of the scrotum?

A: No, neither the CPT 2008 code book nor the ACR Ultrasound Coding User’s Guide stipulates the spermatic cord as a required element to be documented. Also, the ACR Practice Guideline for the Performance of a Scrotal Ultrasound Examination is silent with regard to imaging the spermatic cord.

Q: Can you submit an evaluation and management code for a clinical breast exam performed in conjunction with a screening mammography study?

A: Only the screening mammography code 77057 (Screening mammography, bilateral (2-view film study of each breast)) should be reported. A clinical breast exam performed in conjunction with a screening mammography study would be considered part of the screening mammography procedure. As noted in the ACR Practice Guideline for the Performance of Screening Mammography specifications:

The examination should ordinarily be limited to craniocaudal (CC) and mediolateral oblique (MLO) views of each breast. On occasion, supplemental views may be required to visualize breast tissue completely or optimally, but such views are not ordinarily part of the routine screening examination. When pathology is suspected, a recommendation for additional imaging studies, diagnostic mammography, or biopsy may be warranted.

Evaluation of the augmented breast should include, when possible, standard CC and MLO or lateral views as well as implant displacement views.

Women should be informed that a clinical breast examination is a complementary and recommended procedure.

Q: What are the Physician Quality Reporting Initiative program quality measures for 2008?

A: There were 119 quality measures approved for 2008 in the Physician Quality Reporting Initiative (PQRI) program. These include the 74 measures from 2007 and 45 new measures for 2008. Please be sure to review the PQRI measures listed on the Centers for Medicare and Medicaid Services CMS Web site to determine which measures may be applicable to your practice. For example, a new measure for 2008 is described as Prevention of Catheter-Related Bloodstream Infections (CRBSI) – Central Venous Catheter Insertion Protocol and Measure (measure #76). Also added for 2008 are several measures related to prostate cancer that can be reported by radiation oncologists (measures #101-105).

The ACR and several other medical specialties developed and finalized numerous other measures that were expected to be included in the 2008 listing. However, the Medicare Physician Fee Schedule Final Rule did not include the eight additional new measures requested for radiology. It is ACR’s hope that the final budget bill Congress approves for 2008 will provide authority to include the eight new radiology measures at some point in 2008, without waiting an additional year.

Though Category II codes for the eight new radiology measures are listed on the American Medical Association Web site, please do not report these codes until direction is given from CMS to do so or claims will be rejected. Visit the ACR and CMS Web sites periodically for updates to the PQRI measure sets to determine the active code measures for 2008.

For more information on the eight new measures developed for radiology, see the ACR Web site.

NOTE: A slight modification was made to measure #10, CT/MRI reports for stroke. The ICD-9 codes in the denominator have been expanded to include sign and symptom codes. Please review the revised measure requirements.