The New Year brings a new outlook, new opportunities, and new challenges for our profession. It also brings new Current Procedural Terminology (CPT®) codes. For 2019, radiology has the greatest number of new CPT codes in recent memory. When I say “new,” I mean CPT codes describing new services — innovative services not previously reported. I do not mean revised CPT codes to describe existing services, such as services that are revised due to bundling or in response to the potentially misvalued initiatives. Among the new codes are contrast-enhanced ultrasound, ultrasound elastography, MR elastography, bone density ultrasound, and 3D anatomic modeling (see sidebar).
New code creation is an important step in expanding new services. But additional effort remains.
These new CPT codes are the result of a lengthy process involving dozens of radiology professionals. The ACR’s CPT and RVS Update Committee (RUC) teams of volunteers and staff, led by Mark D. Alson, MD, FACR, and Kurt A. Schoppe, MD, respectively, assumed critical roles. In addition, contributions came from outside the ACR Commission on Economics, outside the College, and even outside radiology. To understand the depth of contributions, we must delve into the requirements for an innovative new service to become a CPT code and achieve valuation:
1. The literature must be robust and supportive. The presence of such literature for these new codes occurs thanks to our researchers, our clinical trials, and our academic institutions.
2. The service must be widely performed. This is a credit to our physicians bringing new services to their patients, even when payment for those services may be uncertain. This is also a credit to our academic and community radiologists willing to provide the service despite the lack of a CPT code and uncertainty regarding payment.
3. Valuation is an important next step. Valuation prompts me to thank the randomly chosen members of our profession who completed the surveys indicating the relative work involved.
New code creation is an important step in expanding new services. But additional effort remains. The ACR will monitor government and private payer coverage policies closely. Payment to physicians is important, but so is payment within such parallel payment systems as the Hospital Outpatient Prospective Payment System (which pays hospitals for outpatient services) and the Inpatient Prospective Payment System (which pays hospitals for inpatient and acute care services). Further, how these new services factor into the Quality Payment Program is relevant. For instance, are there opportunities to propose related and meaningful quality measures within the Merit-Based Incentive Payment System (MIPS)? Where do these services fit in evolving clinical episodic bundles of care? How will they influence MIPS performance categories such as Cost?
The recent CMS and RUC potentially misvalued initiative has disproportionately affected radiology, with an astonishing 46 percent of our codes subject to revision in recent years.1 The consequence in recent years has been a concordant and understandable hesitation to bring forth new codes. We see this trend changing in 2019 as new codes for innovative services are created, making those services available to our patients. The ACR Commission on Economics remains committed to continuing this trend.