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Important changes have been made to the CPT 2013 codebook that will have an impact on radiology practices. These changes are based on the request made by the CPT®/ Relative [Value Scale] Update Committee (RUC) Five-Year Review Identification Workgroup (now known as the Relativity Assessment Workgroup (RAW)) to specialty societies to proceed with code changes to address code pairs reported together more than 75% of the time, and Harvard-valued codes with utilization more than 30,000. Category I codes
Diagnostic Radiology - Cervical Spine Codes (Revised)
Editorial changes were requested to address the confusion that existed between what comprised a complete study (72052) versus a minimum of four views (72050). To accurately define and reflect the work performed by listing the number of views, the cervical spine codes were revised as 72040 for three views or less, 72050 for four or five views and 72052 for six or more views. - Bronchography Codes (Deleted)
Bronchography codes (71040 and 71060) used along with bronchoscopy codes 31656 and 31715 have been deleted for services offered in 2013. It is because bronchography has been replaced with computed tomography. If bronchography is performed in any case, code 76499 (unlisted diagnostic radiographic procedure) should be used. Interventional Radiology - New Codes for Thoracentesis and Pleural Drainage
As the chest tube codes 32422 and 32551 were found as Harvard-based codes having utilization greater than 30,000, RAW (Relativity Assessment Workgroup) requested a resurvey. Before resurveying, specialty societies requested that these services be referred to the CPT Editorial Panel for modifying the coding structure to define current practice. Thus, the new codes (32554, 32555, 32556 and 32557) were introduced. - 32554: Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance
- 32555: with imaging guidance
- 32556: Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance
- 32557: with imaging guidance
(For insertion of indwelling tunneled pleural catheter with cuff, use 32550)(For open procedure, use 32551)(32554-32557 cannot be reported in conjunction with 32550, 32551, 76942, 77002, 77012, 77021, 75989)These codes do not include moderate sedation, which must be reported separately when required. - Deleted Pneumocentesis and Thoracentesis Codes
The pneumocentesis and thoracentesis codes 32420, 32421 and 32422 have been deleted for 2013. - 32420: Pneumocentesis, puncture of lung for aspiration
- 32421: Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent
- 32422: Thoracentesis with insertion of tube, includes water seal (eg, for pneumothorax), when performed (separate procedure)
The code 32551 will not be used any more to describe percutaneous chest tube placement. Instead, it is revised to describe only open procedure – to describe a surgically placed chest tube involving an “actual” thoracostomy, unlike a typical percutaneous tube placement a radiologist may perform. - New Codes for Cervicocerebral Artery Studies
Carotid angiography codes were identified as high frequency code pairs used together more than 75 percent of the time, and therefore they were recommended for bundling. The new codes 36221-36228 describe arterial nonselective and selective catheter placement and diagnostic imaging of the aortic arch, carotid and vertebral arteries. - 36221: Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed. This code cannot be reported along with 36222–36226.
- 36222: Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed
- 36223: Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed
- 36224: Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed
- 36225: Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed
- 36226: Selective catheter placements, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed
- +36227: Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation
- +36228: Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation
The codes +36227 and +36228 are to be listed separately in addition to the primary procedure code; 36227 is to be used along with 36222, 36223 or 36224; and 36228 is to be used in conjunction with 36224 or 36226. The code 36228 cannot be reported more than twice per side. There is no need to report moderate sedation separately as it is included (denoted by bull’s eye) in the new codes. Use the bilateral modifier 50 to report bilateral carotid and/or vertebral arterial catheterization and imaging. In case a different territory is studied during the same session on both sides of the body, use the modifier 59 to indicate that a different carotid and/or vertebral arteries are being studied. - Deleted Cervicocerebral Angiography Codes
The codes 75650, 75660, 75662, 75665, 75671, 75676, 75680, and 75685 (radiological supervision and interpretation codes) have been deleted as the services signified by them have been bundled into new comprehensive codes. - 3D rendering (76376 or 76377) and ultrasound guidance for vascular access (76937) performed along with services denoted by 36221 – 36228 are to be reported separately.
- Do not report code 75774 (Angiography, selective, each additional vessel studied after basic examination, RS&I) when performed as part of a diagnostic angiography procedure of the intracranial and extracranial cervicocerebral vessels.
- Report code 75774 along with the relevant base codes for the additional areas studied, when performed as a diagnostic angiography study of the upper extremities and other vascular beds performed in the same session.
- Foreign Body Retrieval Codes
New bundled code was recommended when the codes 37203 and 75961 were found as being reported together more than 75 percent of the time. Both 37203 and 75961 have been deleted for services rendered in 2013. A new code ? 37197 has been introduced in 2013 which bundles in imaging (Transcatheter retrieval, percutaneous, of intravascular foreign body (e.g., fractured venous or arterial catheter, includes RS&I and imaging guidance (ultrasound or fluoroscopy), when performed). Moderate sedation is included in the new code as denoted by the bull’s eye and should not be separately reported. However, selective catheterization and diagnostic angiography should be reported separately. It was found that the codes 37201 and 75896 were being reported together more than 75 percent of the time. Thus, new codes 37211-37214 have been introduced in 2013 to replace code 37201. As imaging is bundled into the new procedure codes, the imaging codes 75896 and 75898 cannot be used in conjunction with them. The initial day of infusion along with follow-up and catheter position change or exchange should be reported using 37211 and 37212 respectively. The code 37213 should be used for subsequent days of treatment and code 37214 for the final day of treatment. If initiation and completion of treatment are on the same day, then codes 37211 and 37212 should be used. The thrombolysis codes 37201, 37209, and 75900 have been deleted for 2013. Fluoroscopic guidance, radiological supervision and interpretation associated with the guidance, exchange of previous intravascular catheter and moderate sedation are included in the new transcatheter therapy codes whereas catheter placement, diagnostic studies and other percutaneous interventions should be reported separately, if performed. Ultrasound guidance for vascular access performed should be reported separately with code 76937. Modifier 25 should be used if E/M service is offered by the same physician on the same day. Nuclear Medicine - Endrocrine and Parathyroid Codes
It was found that the thyroid code 78007 is a Harvard-valued code having utilization greater than 30,000. Hence, specialty societies requested CPT Editorial Panel review for thyroid and parathyroid codes before submitting the code 78007 to revaluation by RUC (Relative [Value Scale] Update Committee). The aim of this review was to modify the coding structure for describing the types of procedures appropriately as performed in current practice. - As a result, the thyroid codes 78000, 78001, 78006, 78007, 78010, 78011 have been deleted and replaced with codes 78012, 78013, 78014 which will denote thyroid uptake and imaging procedures.
- The parathyroid code 78070 has been revised to include subtraction when planar imaging is performed.
- Two new codes, 78071 and 78072 were introduced to specify Parathyroid planar imaging (including subtraction when performed); with tomographic (SPECT), and Parathyroid planar imaging (including subtraction when performed); with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization respectively.
Radiation Oncology A new Stereotactic Body Radiation Therapy code, 32701 was added under Stereotactic Radiation Therapy in the Surgery/Respiratory section of the CPT 2013 codebook for surgeon/physicians to describe the entire work of determining tumor borders to identify tumor volume, relationship with adjacent structures and availability of the surgeon to identify and validate the thoracic target before treatment delivery when a fiducial-less tracking system is utilized. When this work is done in collaboration with radiation onclogists, they would report the code(s) for clinical treatment planning, treatment delivery and management and other procedures from the Radiation Oncology code section in CPT codebook. Surgeons/physicians were using the unlisted code 32999 to denote this service. The new code 32701 should not be reported more than once for the entire course of treatment even if the treatment requires more than one session. Also, it should not be reported along with radiology oncology codes 77261-77799 or with 31626 or 32553 (in case of fiducial markers placement). Category III codes The prime aim of Category III codes is to track new procedures. Hence, they are not referred to AMA Relative Value Scale Update Committee valuation. However, these codes are priced by carriers if the corresponding service is covered. Updates of these codes are posted biannually. They will become effective after six months from the posting date. Category III codes will be maintained until they achieve the status of Category I codes or they will be archived after five years unless it is demonstrated that there is a need to maintain the Category III code status. - New Category III code, 0301T is listed in the CPT codebook for 2013 for destruction/reduction of malignant breast tumor with externally applied focused microwave, including interstitial placement of disposable catheter with combined temperature monitoring probe and microwave focusing sensocatheter under ultrasound thermotherapy guidance. It is called Focused Microwave Ablation code and is effective from July 1, 2012 onwards.
- 0301T should not be reported in conjunction with 76645, 76942, 76998, 77600-77615.
- CAD and HDR Brachytherapy codes 0174T, 0175T and 0182T have been extended until 2017 as it is expected that these codes will be eligible for Category I code status eventually.
It is advisable to approach a professional medical billing and coding company that offers the service of medical billing and coding professionals well-versed in CPT code updates for 2013 to gain maximum reimbursement. About Author Outsource Strategies International (OSI) is a reliable medical billing and coding company, offers quality services that meet the unique needs of your healthcare practice. We provide medical billing and coding services for all medical specialties.
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