Several radiology codes and guideline revisions will be implemented for 2020. As in past years, many of the 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 Technology (CPT®) Editorial Panel for bundling. Following is a summary of some of the anticipated changes in 2020.
Expecting bundlig of imaging for procedures such as upper gastrointestinal tract imaging and lumbar puncture. In addition, a new family of codes will be available in 2020 to describe nuclear medicine SPECT/CT studies. Code 0482T for absolute quantitatin of myocardial blood flow (AQMBF) and code G0365 for duplex scan arterial inflow and venous outflow upper extremity and will be converted to Category I.
The ACR urges its members to review and consider how the bundled and new code changes may impact their practices.
Diagnostic Radiology/Interventional Radiology
Gastrointestinal Tract Codes
Expect two new codes and revisions to existing codes 74210, 74220, 74230, 74240, 74246, 74250, 74251, 74270, and 74280. Codes 74241, 74245, 74247, 74249, and 74260 will be deleted.
The gastrointestinal tract codes were referred by the RAW to bundle fluoroscopy and condense the family of codes. The codes will be revised to clarify anatomic region and specify the components that are included in order to align with other codes in the radiology code set.
Lumbar Puncture
Code 62270 was referred to the CPT Editorial Panel by the RAW to bundle imaging guidance. Codes 62270 and 62272 will be revised and two new codes will be created that bundle diagnostic and therapeutic lumbar puncture with fluoroscopic or CT guidance.
Duplex Scan Arterial Inflow and Venous Outflow Upper Extremity for Hemodialysis Imaging
Code G0365 was referred by the RAW for conversion to Category I. Anticipate two new codes that describe duplex scan or arterial inflow and venous outflow for preoperative vessel assessment prior to the creation of hemodialysis access.
Nuclear Medicine
SPECT/CT
Look for a new set of generic codes modeled after the current nuclear medicine tumor and radiopharmaceutical distribution codes to be available. The new codes will represent a wide variety of planar, SPECT and SPECT/CT studies.
Codes 78800, 78801, 78802, 78803, and 78804 will be revised and three new codes created to include inflammatory process, vascular flow, and blood pool flow imaging. The codes will specify whether planar, SPECT, or SPECT/CT was performed.
Also, a new add-on code will be available to describe radiopharmaceutical quantification measurements. Codes 78205, 78206, 78320, 78607, 78647, 78710, 78805, 78806, and 78807 will be deleted.
Myocardial PET
Code descriptors for the myocardial PET codes 78459, 78491, and 78492 will be updated to include ventricular wall motion and ejection fraction when performed. In addition, six new codes will be created to describe myocardial PET perfusion and myocardial PET perfusion with metabolic evaluation to include ventricular wall motion and ejection fraction when performed, the codes will also specify whether concurrently acquired CT transmisson images for anatomical review was performed.
Category III code 0482T for AQMBF will be converted to a Category I, and therefore will be deleted.
These updates will capture wall motion, ejection fraction, flow reserve, and newer hardware and software technology used in myocardial PET imaging.
Category III
3D Anatomic Modeling
Four new Category III codes will be created for 3D printing of anatomic models and cutting/drilling guides. The new codes will be effective July 1, 2019.
This summer the Economics and Health Policy eNews section of the ACR website will post an impact analysis of the 2020 code changes to help radiology and radiation oncology practices prepare for the 2020 changes. In addition, the September/October 2019 issue of the ACR Radiology Coding Source will include a list of the new 2020 codes and descriptors pertinent to radiology.
In August, the AMA will provide an early release of the downloadable version of the CPT2020 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 Novemeber of the calendar year before the codes become effective. Be sure to check the complete listing of code changes in the AMA’s CPT 2020 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 meetings. Future Editorial Panel actions may affect these actions. 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 2019.