Numerous radiology codes and guideline revisions will be implemented for 2019. As in the past, 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 as potentially “misvalued” services. Code pairs identified as being performed together 75 percent or more of the time and, therefore, referred to the Current Procedural Terminology (CPT®) Editorial Panel for bundling. Following is a summary of some the anticipated changes in 2019.
Expect bundling for fine needle aspiration biopsy, breast MRI with computer-aided detection (CAD), dilation of urinary tract, and peripherally inserted central venous catheter (PICC) line codes. In addition, new Category I codes will be introduced to describe contrast-enhanced ultrasound (CEUS) and magnetic resonance elastography (MRE). Also, Category III codes that exist for ultrasound elastography (USE), and breast MRI with CAD will be converted to Category I code status.
New Category III codes will be available to report pulse-echo ultrasound bone mineral density analysis (BMD), and positron emission tomography (PET) absolute quantification myocardial blood flow studies. Category III codes allow for more appropriate documentation and tracking of the use of these technologies.
The ACR urges its members to review and consider how the bundled and new code changes may impact their practices.
Diagnostic Radiology
Fine Needle Aspiration Codes
Expect revision to the fine needle aspiration code 10021, deletion of 10022, and the addition of nine new codes that bundle the procedure and the radiological supervision and interpretation.
Fine needle aspiration code 10022 was identified by the RAW as being reported together with 76942 more than 75 percent of the time, resulting in referral to the CPT Editorial Panel for a bundling.
Breast MRI with CAD
Codes 77058, 77059 and 0159T are proposed to be deleted and replaced with four new breast magnetic resonance imaging codes: two codes to report breast MRI with and without contrast, and two codes that bundle computer-aided detection (CAD). The new codes will convert breast MRI with CAD from Category III to Category I.
Knee Arthrography
Injection of contrast for knee arthrography, code 27370, was identified by the RAW as a potentially misvalued service. The high volume growth for this procedure is likely due to it being reported incorrectly as arthrocentesis or aspiration. As a result, the RAW recommended that code 27370 be referred to the CPT Editorial Panel for deletion and be replaced with a new code to report the injection procedure for knee arthrography or CT/MRI knee arthrography.
Ultrasound Elastography (USE)
Three new Category I codes will be established for ultrasound elastography, the new codes will distinguish reporting per organ, first target lesion, and each additional target lesion. Category III code 0346T is proposed for deletion.
Magnetic Resonance Elastography (MRE)
Magnetic resonance elastography (MRE) is a new diagnostic imaging technology; currently there is no CPT code available to describe this procedure. A new code is proposed to be available to report this service.
Contrast Enhanced-Ultrasound (CEUS)
Look for two new codes to report ultrasound procedures that use dynamic microbubble-sonographic contrast with targeted ultrasound to evaluate lesions.
Fluoroscopy
Fluoroscopy code 76001 is proposed to be deleted due to low volume reporting as this service is rarely performed and to address concerns of miscoding.
Interventional Radiology
Peripherally Inserted Central Catheter (PICC)
The PICC line codes were referred from the RAW to bundle imaging. Two new codes will be available that describe PICC line procedures that bundle imaging guidance, image documentation and all associated radiological supervision and interpretation. The introductory language and parentheticals will be updated to assure that codes 36568 and 36569 are used to report PICC placement without imaging guidance, and code 36584 will be revised to include imaging guidance, image documentation, and radiological supervision and interpretation required to perform the replacement. The central venous access procedures guidelines in the CPT codebook will also be updated to reflect these changes.
Gastrostomy Tube Replacement
The RAW survey data showed several different specialties and providers report code 43760. To address the differences in physician work, code 43760 will be deleted and replaced with two new codes that define simple versus complex replacement of a percutaneous gastrostomy tube.
Dilation of Urinary Tract
Anticipate two new codes to report dilation of the urinary tract for endourologic procedures; code 50395 will be deleted. Guidelines on how to report the new codes will be included in the introduction of the urinary system section of the CPT codebook.
Category III
Bone Density Ultrasound
Look for a new Category III code to be available to report pulse-echo ultrasound bone density measurements for bone mineral density analysis.
PET Absolute Quantitation Myocardial Blood Flow
A new Category III code is proposed to report positron emission tomography (PET) for the absolute quantitation of myocardial blood flow at rest and stress.
MIPS Patient Relationship Modifiers
Under the Merit-based Incentive Payment System (MIPS) five patient relationship modifiers are proposed to be developed for 2019. The modifiers will attribute a patient to the physician(s) who is responsible for particular services in order to assess resource use and care episodes for the MIPS Cost performance category.
This summer the Economics & Health Policy eNews section of the ACR website will post an impact analysis of the 2019 code changes to help radiology and radiation oncology practices prepare for the 2019 changes. In addition, the September/October 2018 issue of the ACR Radiology Coding Source will include a list of the new 2019 codes and descriptors pertinent to radiology.
In August, the AMA will provide an early release of the down¬loadable version of the CPT 2019 codebook from the AMA Bookstore. The Centers for Medicare and Medicaid Services (CMS) approves values for codes, how¬ever, the values will not be known until the Medicare Physician Fee Schedule Final Rule is published in the Federal Register, typically in November. Be sure to check the complete listing of code changes in the AMA’s CPT 2019 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 meeting. Future Editorial Panel actions may affect these items. Note that specific code numbers have not been assigned and wording has not been finalized until just prior to publication. The release of specific CPT code set infor¬mation is timed with the release of the entire code set in the CPT publication.