Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete limited

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1 Radiology CPT Coding Updates for 2015 Note: This article contains coding information from the 2015 Physician's Current Procedural Terminology (CPT ) Manual. CPT is a registered trademark of the American Medical Association. CPT five-digit codes, nomenclature, and other data are copyright 2015 American Medical Association. All rights reserved. This month we take a look at the major changes to Radiology coding and billing for Again this year, CMS continues the process of bundling radiology services wherever possible. We also have new codes to clarify some services. Judy Riley, RHIT, CCS, CPC COO. Medical Reimbursement Specialists, LLC; aid [email protected] Breast Ultrasound and Tomosynthesis Until now there has been a single CPT code for breast ultrasound, whether it was performed bilaterally, unilaterally, completely or limited. New codes and now describe unilateral complete and limited examinations, and Medicare has indicated that bilateral studies will be paid at 150% of the unilateral rate when Modifier -50 is applied. According to the American College of Radiology, a complete examination includes all four quadrants of the breast and the retroareolar region; it also includes ultrasound examination of the axilla if performed. A study that does not meet these criteria is considered to be limited. As with all ultrasound examinations, there must be a thorough evaluation of the anatomic area, image documentation, and a final written report to ensure that it is separately reportable Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete limited We also now have three codes for digital breast tomosynthesis (DBT) that cover screening and diagnostic studies is an add-on code that is reported together with the screening mammogram code Digital breast tomosynthesis; unilateral bilateral Screening digital breast tomosynthesis, bilateral (list separately in addition to code for

2 primary procedure) G-codes for Medicare Reporting: The codes for diagnostic tomosynthesis (77061 and 77062) are not valid for Medicare billing. Instead, report diagnostic tomosynthesis services for Medicare beneficiaries using HCPCS code +G0279 [Diagnostic digital breast tomosynthesis, unilateral or bilateral (List separately in addition to G0204 or G0206)]. Unlike and 77062, G0279 is an add-on code and cannot be reported as a stand-alone service. By defining DBT using an add-on code, there is no way to code for diagnostic breast tomosynthesis when it is performed separately from a full-field digital mammogram. Also, while Medicare elected not to use the newly-created CPT codes and 77062, commercial payers have the option to do so. Make sure your facility does its due diligence with each of your major payers to understand which codes to use for optimal coverage of DBT. The new add-on codes are paid at approximately $30.79 for the Professional Component and $25.78 for the Technical Component ($56.57 for global services) in addition to the regular payment for the screening or diagnostic mammogram. If your facility does not currently offer DBT, now is the time to consider investing in the equipment to take advantage of this revenue opportunity. Analyze your mammography volume by payer and investigate your major payers policies to estimate the financial impact of adding DBT services. Myelography Two myelogram injection codes have been revised and four new comprehensive codes have been established for myelogram contrast injection and imaging. For the injection codes, the description of has been changed and the words "(eg, C1-C2)" have been removed, presumably to eliminate redundancy. Also, the description of was changed from "Injection spinal" to "Injection lumbar." Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment Injection procedure for myelography and/or computed tomography, lumbar (other than C1-C2 and posterior fossa) Myelography via lumbar injection, including radiological supervision and interpretation; cervical thoracic lumbosacral

3 62305 two or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical) The new comprehensive codes include the lumbar injection as well as the myelogram supervision and interpretation. The existing myelogram imaging codes ( ) were not deleted for 2015 because different physicians perform the injection and the imaging guidance in some situations. If the same physician performs the entire procedure, the comprehensive is submitted. For a thorough discussion of the correct application of these codes see the September 2014 issue of CPT Assistant. Briefly, do not report myelography solely for the documentation of needle placement; a complete procedure with full imaging must be performed and documented. In addition clarifying language states that "the supervision and interpretation for myelography should not be reported without the referring physician or other qualified health care professional requesting an X-ray myelogram." Additional information recommended appending modifier 59 to the CT of the spine if performed on the same day as a traditional X-ray myelogram. Features unique to Myelography A myelogram is the imaging study of the thecal sac and its contents after injection. A myelogram is NOT a report describing only a few images documenting intrathecal needle placement. A myelogram provides imaging of the entire region of the spine on a single image. In some cases various special techniques may be used, such as a tilt table, natural weight bearing, lateral mending, flexion, and hyperextension to detect lateral recess nerve root compression and spinal stenosis. Vertebroplasty, Vertebral Augmentation (Kyphoplasty), Sacroplasty Three new vertebroplasty codes now include all imaging guidance. Instead of codes for thoracic and lumbar vertebroplasty, CPT now provides codes for cervicothoracic and lumbosacral procedures. All of the vertebroplasty, kyphoplasty, and sacroplasty codes include bone biopsy when performed at the same level Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic lumbosacral each additional cervicothoracic or lumbosacral vertebral body (list separately in addition to code for primary procedure)

4 Three new vertebral augmentation (kyphoplasty) codes ( ) have also been established. Once again, these codes include all imaging guidance. Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), one vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic lumbar each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure) The Category III sacroplasty codes (0200T-0201T) have been revised to include imaging guidance and bone biopsy as well. Other Changes Arthrocentesis: The three arthrocentesis codes have been revised to specify procedures performed without ultrasound guidance, and three new codes (20604, 20606, 20611) have been added for procedures performed with ultrasound guidance. The Category III code for sacroiliac joint stabilization/arthrodesis (0334T) has been deleted and replaced with a Category I code (27279). Tumor ablation: The bone tumor ablation code (20982) has been revised to indicate that the procedure is for reduction or eradication of the tumor(s) and includes adjacent soft tissue involved by tumor extension. It also includes imaging guidance when performed. We have a new code (20983) for cryoablation of bone tumors, and a new code for percutaneous cryoablation of liver tumors (47383). Fenestrated endovascular aortic repair (FEVAR): has been created for physician planning that requires at least 90 minutes. Carotid and vertebral stents: The codes for transcatheter carotid stent placement ( ) have been revised and a new code (37218) for open or percutaneous antegrade approach treatment of intrathoracic common carotid artery or innominate artery has been added for Vertebral fracture assessment (VFA): Two new VFA codes ( ) have been created is a combination code that includes axial dual-energy X-ray absorptiometry (DXA) as well as VFA, while represents a stand-alone VFA. Continue to report 77080, whenever DXA is performed without VFA.

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