December 31, 2013

ACR Radiology Coding Source™ November-December 2013 Q and A

Q: If a patient had breast cancer identified several years ago, but the imaging is now negative, are we still required to address the malignancy by using the Physician Quality Reporting System CPT Category II code 3350F, Mammogram assessment category of "known biopsy proven malignancy," documented (RAD)5, in addition to or in place of the 3341F, Mammogram assessment category of "negative," documented (RAD)5 ?

A: According to the ACR’s Breast Imaging-Reporting and Data System (BI-RADS®) guidelines, if the current breast exam is negative, a BI-RADS® 1 (negative) code should be assigned, as this study is independent of the previous cancer history. The appropriate CPT II quality data code to report, therefore, is 3341F, Mammogram assessment category of "negative," documented (RAD) 5.

Q: Prior to 2014, there were separate codes for a spring-loaded biopsy device and for a vacuum-assisted or mechanical rotating device. How and why have these been bundled into the new breast biopsy codes?

A: With the Centers for Medicare and Medicaid Services (CMS) requirement for bundling, we were requested by the CPT/Relative Value Scale Update Committee (RUC) Workgroup to collapse the breast biopsy procedures and devices into a single code. When presenting the data to the RUC for valuation, the ACR was required to present the time, intensity, and practice expense for the "typical patient" for those procedures. Because the vacuum biopsy needles have become so common and, in fact, are the most typical biopsy devices used for image-guided breast biopsies, the ACR asserted that those needles were in fact "typical" and all the work, time, and practice inputs that were presented to the RUC to develop the RVUs for these new codes are based on the vacuum needles rather than the spring needles.
The new global reimbursement rate for the biopsy codes is less than the sum of the prior individual code reimbursements. This is the problem with all of the bundling that is being required of all specialties. The ACR and other radiology specialty societies are doing our best to maintain appropriate reimbursement for these procedures in this difficult climate.