New Category III codes were created in the Radiology section of the Current Procedural Termi¬nology (CPT®) 2021 code set. In addition to these codes, several new codes are being added in 2022, and two early-release Category III codes are forthcoming in July 2021 as well. This article provides an overview of the new Category III codes added to the 2021 code set, the early-release codes, and the anticipated changes in 2022.
Category III codes enable more appropriate docu¬mentation and usage tracking of new technologies. For CPT 2021 and early-release codes, Category III codes were created to report emerging technologies that included breast computed tomography (CT); quantitative multiparametric magnetic resonance imaging (mp-MRI); percutaneous allogeneic injec¬tion of the lumbar spine; and automated advanced coronary analysis. For CPT 2022, Category I and Category III codes will be created to report trabec¬ular bone score (TBS); thermal destruction of the intraosseous basivertebral nerve; quantitative ultra¬sound tissue characterization (non-elastographic); and artificial intelligence (AI) analysis for detection of vertebral fractures.
The ACR urges its members to review and consider how the bundled and new code changes may impact their practices.
CPT 2021 CODE SET: NEW CATEGORY III CODES
Several new Category III codes were created in the CPT 2021 code set, which are also available on the American Medical Association’s (AMA’s) website with an effective date of January 1, 2021. These codes are summarized below.
Breast Computed Tomography
Six new codes (0633T-0638T) have been created in the CPT 2021 code set: three unilateral codes, three bilateral codes to report breast CT without contrast, breast CT with contrast, and breast CT without and with contrast, respectively.
Prior to May 2020, there were no CPT codes available to report breast CT. Existing chest CT and CT angi¬ography (CTA) imaging and equipment optimization for detection of breast lesions are sufficiently differ¬ent than conventional chest CT to justify the creation of a separate Category III coding family.
Percutaneous Lumbar Spine Allogeneic Injection
Four codes (0627T-0630T) were created in the CPT 2021 code set, and they are now available to report percutaneous injection of allogeneic cellular and/or tissue-based products.
Percutaneous allogeneic injection of the lumbar spine is a new therapeutic procedure that involves imaging-guided injection of the lumbar spine using allogeneic cellular and/or tissue-based products to replace or supplement the disc tissue or cells to repair or reconstitute damaged intravertebral disc(s).
Automated Advanced Coronary Analysis
Four new codes (0623T-0626T) were created and are now available to report automated quantifica-tion and characterization of coronary atherosclerotic plaque using the raw data obtained from CCTA. In addition, the guidelines in the Diagnostic Radiology section were revised and updated to incorporate these new codes in the CPT 2021 code set.
Automated advanced coronary analysis uses computer algorithms to provide additional analysis of coronary CTA (CCTA) beyond the conventional interpretation of CCTA.
CATEGORY III CODES: EARLY RELEASE IN 2020
The following Category III codes were early released in December 2020 with an effective date of July 1, 2021, and made available to the public on the AMA’s website.
Two codes (0648T, 0649T) were established for reporting quantitative mp-MRI for the analysis of tissue composition, including multiparametric data acquisition, data preparation and transmission, and interpretation and report that is obtained either with or without a concurrent diagnostic MRI.
Quantitative mp-MRI is a new technology that does not have a CPT code currently. Quantitative mp-MRI uses software to analyze tissue physiology of visceral organs and other anatomic structures non-invasively, and is a tool to assist in physician decision-making.
CPT 2022 CODE SET: NEW CATEGORY I CODES
New Category I radiology diagnostic codes will be added to the CPT 2022 code set, which will be avail¬able for reporting on January 1, 2022.
Diagnostic Radiology: Trabecular Bone Score
Four new codes will be available for reporting trabecular bone score (TBS).
TBS measures the structural condi¬tion of the bone micro-architecture, which predicts the risk of major osteoporotic fracture independent of bone mineral density (BMD) and clinical risk factors.
Diagnostic Radiology: Destruction of Intraosseous Basivertebral Nerve
Two new codes will be created to report thermal destruction of the intraosseous basivertebral nerve. This is a new procedure that provides effective relief for patients suffering from certain types of chronic low-back pain.
In addition to the new codes, a parenthetical note to direct users to these new codes will be added in the Percutaneous Vertebroplasty and Vertebral Augmen¬tation subsection of the Musculoskeletal section of the CPT 2022 code set.