Several radiology codes and guideline revisions will be implemented beginning January 1, 2021. As in past years, many of the new codes have been created as a result of bundling mandates from the American Medical Association’s (AMA) Relativity Assessment Workgroup (RAW) for the purpose of identifying what it considers potentially “misvalued” services. The RAW required specific codes be referred to the Current Procedural Terminology (CPT®) Editorial Panel for evaluation. This often results in bundling of the codes found to be reported together. For 2021, the referral included percutaneous core needle lung biopsy with imaging guidance.
In addition, two new Category I codes will be introduced to describe medical physics dose evaluation and low-dose computed tomography (CT) of the thorax for lung cancer screening. Category III codes will also be available July 1, 2020 for new procedures, such as irreversible electroporation (IRE) ablation and magnetic resonance spectroscopy (MRS).
Also, there will be significant revisions to the office or other outpatient evaluation and management (E/M) visit codes.
The ACR urges its members to review and consider how the bundled and new code changes may impact their practices.
DIAGNOSTIC RADIOLOGY
Screening CT of Thorax
Expect editorial revisions to the CT of thorax codes 71250, 71260, 71270 specifying these codes are diagnostic. Also, a new CT of thorax code will be available to report low-dose lung cancer screening.
Healthcare Common Procedure Coding System (HCPCS) code G0297 was identified on the Centers for Medicare and Medicaid Services (CMS) high value growth screen and, therefore, was referred to the CPT® Editorial Panel to establish a Category I CPT® code to report low-dose CT for lung cancer screening.
Urography
Code 74425 will be editorially revised and a reciprocal parenthetical will be added clarifying that it can be reported with codes 50390, 50396, 50684, and 50690.
Fluoroscopic Guidance
Codes 64400-64450 and 64455 (introduction/injection of anesthetic agent and/or steroid into the somatic nervous system) were not listed in the inclusionary parenthetical notes following fluoroscopic guidance codes, these codes will be added in the inclusionary parenthetical notes following codes 77002 and 77003.
Ultrasound Follow-up Study
Code 76970 was identified on the RAW’s CMS/Other source codes screen, and therefore referred to the CPT Editorial Panel for deletion due to low volume.
INTERVENTIONAL RADIOLOGY
Percutaneous Core Needle Lung Biopsy
Code 32405 will be deleted and replaced with a new code that bundles percutaneous core needle lung biopsy with imaging guidance, when performed.
Codes 32405 and 77012 were identified by the RAW as code pairs being performed together 75 percent or more of the time, therefore were referred to the CPT® Editorial Panel for bundling.
MEDICAL PHYSICS
Medical Physics Dose Evaluation
Look for a new Category I code in the Radiology, Diagnostic Radiology (Diagnostic Imaging), Other Procedures subsection of the CPT®codebook to report the assessment and calculation of radiation dose and the potential adverse iatrogenic effects received by the patient that may require follow-up observation or treatment. This is a technical component only code as this service is typically performed by a medical physicist.
CATEGORY III
The following codes will be available on July 1, 2020.
Irreversible Electroporation (IRE) Ablation
Anticipate two new Category III codes to be available for reporting irreversible electroporation (IRE) ablation, a new procedure that uses high voltage electrical impulses for the treatment of cancer.
Magnetic Resonance Spectroscopy (MRS)
Four new Category III codes will be available to report magnetic resonance spectroscopy (MRS) for the determination and localization of discogenic spine pain (cervical, thoracic, or lumbar).
EVALUATION AND MANAGEMENT
Office or Other Outpatient Evaluation and Management (E/M) Visit
The CPT® Editorial Panel approved significant revisions of the office or other outpatient visit E/M code descriptors and guidelines for publication in the CPT® 2021 code set. As part of CMS’ initiative to reduce unnecessary documentation requirements, minimize the need for audits, and ensure payment levels for office or other outpatient evaluation and management (E/M) visit codes are resource-based, the AMA convened the CPT® and Specialty Society Relative Value Scale (RVS) Update Committee (RUC) Evaluation and Management (E/M) Workgroup. The Workgroup provided recommendations to the CPT® Editorial Panel based on input by medical specialty societies.
As a result, new patient code 99201 will be deleted and the code descriptors will be editorially revised for codes 99202, 99203, 99204, and 99205, and established patient codes 99211, 99212, 99213, 99214, and 99215. Prolonged services codes 99354, 99355, and 99356 will also be revised to reflect these changes.
There will also be a new add-on code created to report additional physician time in 15-minute increments. This add-on code will be reported in conjunction with codes 99205 and 99215.
Additionally, history and/or physical examination as a component for code selection will be eliminated; code level selection will be based on medical decision making (MDM) or time. There will also be changes in the definition of MDM and time when used with these codes. The E/M guidelines will be revised extensively to reflect these changes.
For detailed information on the office or other outpatient E/M visit 2021code revisions, refer to CPT®Assistant articles:
February 2020 issue: E/M Office Visit Revisions for 2021: An Overview
March 2020 issue: E/M Office or Other Outpatient Visit Revisions for 2021: Time
This summer the Economics & Health Policy eNews section section of the ACR website will post an impact analysis of the 2021 code changes to help radiology and radiation oncology practices prepare for the 2021 changes. In addition, the September/October 2020 issue of the ACR Radiology Coding Source will include a list of the new 2021 codes and descriptors pertinent to radiology.
In August, the AMA will provide an early release of the downloadable version of the CPT 2021 codebook from the AMA Bookstore. The Centers for Medicare and Medicaid Services (CMS) approves values for codes, however, the values will not be known until the Medicare Physician Fee Schedule Final Rule is published in the Federal Register, typically in November of the calendar year before the codes become effective. Be sure to check the complete listing of code changes in the AMA’s CPT 2021 codebook.
Note: The AMA posts a Summary of Panel Actions, which is available for public viewing. To reiterate, while this summary lists the code changes proposed and the actions taken by the CPT Editorial Panel, the AMA cautions that these actions are a reflection of the discussions at the most recent CPT Editorial Panel meetings. Future Editorial Panel actions may affect these items. Note that specific code numbers have not yet been assigned and wording has not been finalized until just prior to publication. The CPT 2020 Data File with specific CPT code set information is scheduled for release in August 2020.