January 2012
A Look at Coding in the Year Ahead
By Shelly Cronin, CPC, CPMA, CANPC, CGSC, CGIC
Radiology Today
Vol. 13 No. 1 P. 12
Get ready for some administrative upheaval as coding changes abound in 2012. Not only do radiology providers have ICD-10 to prepare for in 2013, but they also have several code changes that will affect reimbursement this year.
The biggest change in radiology coding for 2012 is the continuation of combining codes, which began in 2010. The purpose of combining codes is to reduce payments for procedures performed together more than 75% of the time, per the Centers for Medicare & Medicaid Services (CMS).
For example, in 2010, if a patient had a CT scan of the abdomen and pelvis, you could use two separate codes to report one for each service. Then in 2011, these codes were combined and offered in three separate combined codes:
• 74176, Computed tomography, abdomen and pelvis, without contrast material
• 74177, Computed tomography, abdomen and pelvis, with contrast material(s)
• 74178, Computed tomography, abdomen and pelvis, without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions
For 2012, these changes continue with new and revised codes in various sections of the CPT manual.
What’s New
Vascular: The vascular interventional radiology procedural section has several new codes that will affect reimbursement. Note that these codes include catheter placements and imaging for both unilaterally and bilaterally performed procedures:
• 36251, Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral
• 36252, Same procedure as 36251, only performed bilaterally
• 36253, Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral
• 36254, Same procedure as 36253, only performed bilaterally
Other new codes in this section include the insertion, repositioning, and retrieval of an intravascular vena cava filter when performed via an endovascular approach:
• 37191, Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
• 37192, Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
• 37193, Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
These codes also include parenthetical notes that state not to report with the codes for transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter).
Spinal interventions: In recent years, there have been several changes with spinal interventions to include CT or fluoroscopic guidance. This year is no different, as we see four new codes for paravertebral facet destructions:
• 64633, Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint
• 64634, Same as 64633 only performed on more than one facet joint. (List joints separately in addition to code for primary procedure.)
• 64635, Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint
• 64636, Same as 64635, only performed on more than one facet joint. (List joints separately in addition to code for primary procedure.)
Radiology: For the radiology section of the 2012 CPT manual, there are several changes. We now have a new code for a CT angiography of the abdomen and pelvis, which is a continuation of the changes made in the past with CT scans of the abdomen and pelvis. Documentation of these services must be clear and concise; if a provider performs a CT angiogram of the abdomen or pelvis alone, then it would use the existing codes for that procedure, 74175 and 72191, rather than this new code:
• 74174, Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing
Nuclear medicine: The nuclear medicine section also has several new codes, mainly with intraoperative radiation treatments and one new code for intraoperative radiation treatment management. The two procedural codes are dependent on the mode of treatment, either via X-ray or electrons.
• 77424, Intraoperative radiation treatment delivery, X-ray, single treatment session
• 77425, Intraoperative radiation treatment delivery, electrons, single treatment session
• 77469, Intraoperative radiation treatment management
Additional codes for nuclear medicine include two new codes for hepatobiliary system imaging services, previously reported with code 78223. Now there’s a code for the imaging of the hepatobiliary system alone and a code that includes pharmacologic interventions, including quantitative measurements. Both of these codes include imaging of the gallbladder when present.
• 78226, Hepatobiliary system imaging, including gallbladder when present
• 78227, Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed
Code Deletions and Revisions
For 2012, CPT has deleted the codes 49080 and 49081, which have been replaced with 49082 and 49083 to report abdominal paracentesis procedures. These codes differ from the deleted ones in that there is the designation of imaging guidance usage and the verbiage of initial and subsequent has been removed.
• 49082, Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance
• 49083, Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance
A new code has also been added in this section for peritoneal lavage, which also includes image guidance when performed.
• 49084, Peritoneal lavage, including imaging guidance, when performed
Pulmonary imaging: The pulmonary imaging codes have also experienced major revisions for 2012. This includes condensing nine codes, 78584 to 78596, into four codes to cover the same services.
• 78579, Pulmonary ventilation imaging (eg, aerosol or gas)
• 78582, Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging
• 78597, Quantitative differential pulmonary perfusion, including imaging when performed
• 78598, Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed
The true impact on reimbursement from these changes remains to be seen and will be answered when Medicare releases its fee schedule for the year’s new codes.
— Shelly Cronin, CPC, CPMA, CANPC, CGSC, CGIC, is the CEU vendor department head at AAPC. A seasoned coder, she holds multiple certifications in auditing, anesthesia and pain management, general surgery, and gastroenterology.
