There were a number of radiology and radiation oncology code pairs identified as being performed together 75 percent or more of the time and, therefore, referred to the CPT Editorial Panel for bundling in 2016. The procedure codes identified as inherently performed together include: hip/pelvis radiographs, intravascular ultrasound, percutaneous genitourinary and biliary interventions, and interstitial radiation source application procedures.
In addition, a number of new codes have been created to describe procedures that are currently not described within the CPT code set, such as fetal MRI, sclerotherapy and soft tissue marker placement.
The ACR urges its members to review how the following procedures are coded currently and to anticipate how the bundled and new code changes may impact their practices.
Diagnostic Radiology
Laryngography
A multispecialty society proposal requested the deletion of the laryngography code 70373, as laryngography has been replaced by endoscopy and computed tomography (CT).
Thoracolumbar Spine X-rays
Expect revision to the thoracolumbar spine code 72080; deletion of spine codes 72010, 72069, and 72090; and addition of four new codes to standardize the hierarchy and nomenclature for the thoracolumbar code family to be in line with other spine code families.
Hip/Pelvis X-rays
Look for the establishment of 8 new codes to report bundled hip and pelvis radiologic exams and deletion of current codes 73500, 73510, 73520, 73530, 73540, and 73550. The existing one or two-view pelvis exam code will remain.
Codes 72170 and 73500 were identified as codes reported together greater than 75 percent of the time and, therefore, referred back to CPT for a bundled code.
CPT codes 73520 and 73550 are old codes with utilization greater than 250,000 and 500,000, respectively, that have never been valued by the Relative Value Scale Update Committee (RUC).
Editorial Change of Radiology Descriptors Containing the Word “Film”
Editorial revision to the CPT descriptors of codes that contain the term “film(s)” is required to reflect the transition to digital imaging. Look for editorial revision to codes 74240, 74241, 74245, 74246, 74247, 74250, 74251, 74340, 77057, and 77417 to designate “image(s).” The replacement of the term “film(s)” with the term “image(s)” is consistent with the other imaging codes in the CPT code set.
Fetal MRI
Two new codes to describe fetal MRI are proposed for CY2016. Currently, fetal MRI is reported with an unlisted code or with the pelvic MRI codes 72195-72197.
Interventional Radiology
Intracranial Endovascular Intervention Bundling
A new code that describes percutaneous endovascular revascularization of cerebral vessels occluded by thrombus or embolus, and two new codes that describe prolonged intracranial arterial continuous infusion of pharmacologic agents are proposed. In addition, mechanical thrombectomy codes 37184, 37186, and transcatheter therapy code 37211 will be revised.
Intravascular Ultrasound (IVUS) Bundling
Two new IVUS codes are proposed to bundle radiological supervision and interpretation codes 75945 and 75946 with their related surgical procedure codes 37250 and 37251. In addition, the original stand-alone IVUS codes 37250, 37251, 75945, and 75946 are proposed for deletion. Guidelines on how to report intravascular ultrasound during venous and arterial contrast angiography and endovascular intervention procedures will be provided.
Genitourinary Codes (Nephrostogram, Nephrostomy, Ureteral Stent, Nephrostomy Tube)
The Joint CPT-RUC Workgroup identified genitourinary codes 50392 and 74475, 50393 and 74480, 50394 and 74425, and 50398 and 75984 as codes reported together 75 percent or more of the time.
Establishment of 11 new codes and deletion of codes 50392-50394, 50398, 74475, and 74480 are proposed for 2016. However, a number of genitourinary codes will remain and continue to be reported with supervision and interpretation codes.
In addition, look for three new CPT Category I codes that describe brush biopsy, ureteral dilation, and ureteral embolization.
Percutaneous Biliary Procedure Bundling
In response to a CPT/RUC workgroup mandate, a multispecialty proposal to add 14 new bundled percutaneous biliary codes and to delete the current stand-alone codes (47500, 47505, 47510, 47511, 47525, 47530, 47560, 47561, 47630, 74305, 74320, 74327, 75980, and 75982) was submitted for CY2016.
The specialty societies also proposed coding refinements for reporting of established procedures that are currently reported using endoscopic codes or unlisted codes.
Percutaneous Image-Guided Sclerotherapy of Fluid Collection
Look for a new Category I code to describe percutaneous sclerotherapy of fluid collections. Currently, this procedure is described by the unlisted code or open surgical procedure codes.
Soft Tissue Marker Placement
While there are codes for marker or fiducial placement elsewhere in the body (e.g., 32553, 49411, 55876, 19081-19086, and 19281-19287), currently, there are no codes to describe soft tissue marker placement.
As placement of markers is becoming increasingly more important, two new category I CPT codes, which bundle in imaging guidance, have been requested to describe percutaneous placement of a marker for soft tissue localization.
Nuclear Medicine
Gastric Emptying With Small Bowel and Colon Transit
Two new codes to describe small-bowel and colon transit scintigraphy and revision of the gastric emptying code 78264 are proposed for 2016. This scintigraphic method allows the determination of both total and regional times for gastrointestinal transit.
Radiation Oncology
Interstitial Radiation Source Application
Revision of code 77778 and deletion of codes 77776-77777 which describe interstitial radiation source application are proposed for CY2016.
The RAW identified that CPT code 77778, Interstitial radiation source application; complex, is being reported with 77790, Supervision, handling, loading of radiation source, as part of the 75 percent billed together screen. As the predominant use of 77776-77778 is for permanent seed prostate low-dose rate (LDR) brachytherapy, it was proposed that this family of codes be compressed into one code, 77778, which will incorporate the work of supervision and handling of the sources, 77790.
Category III Codes
Two new Category III codes will be created to describe high dose rate electronic brachytherapy - one for skin surface application and one for interstitial or intracavitary treatment. The current HDR electronic brachytherapy code 0182T is scheduled for deletion.
The CPT Category III coding guidelines will be revised to note that the inclusion of a service or procedure in this section does not constitute a finding of support, or lack thereof, with regard to clinical efficacy, safety, applicability to clinical practice, or payer coverage.
This summer the Economics & Health Policy eNews section of the ACR website will post an impact analysis of the 2016 code changes to help radiology and radiation oncology practices prepare for the 2016 changes.
The September/October 2015 issue of the ACR Radiology Coding Source will publish a listing of the new 2016 codes and descriptors pertinent to radiology.
In August, the AMA will provide an early release of a downloadable version of the CPT® 2016 code book from the AMA Bookstore. The CMS-approved values for codes, however, will not be known until the Medicare Physician Fee Schedule Final Rule is published in the Federal Register, typically in November.
Note: The AMA posts a Summary of Panel Actions that is available for public viewing. While this summary lists the code changes proposed and the actions taken by the panel, the AMA cautions that these actions are a reflection of the discussions at the most recent panel meeting. Future panel actions may impact these items. Codes are not assigned, nor exact wording finalized, until just prior to publication. Release of this more specific CPT® code set information is timed with the release of the entire set of coding changes in the CPT publication.