CPT Code Changes for 2013

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1 CPT Code Changes for 2013 RADIOLOGY Cathy Woodall, CHC, CPC Nicholas Parish, CHC Compliance-Radiology McKesson Revenue Management Solutions This commentary is a summary prepared by McKesson s Revenue Management Solutions division and highlights certain changes, but not all changes, in 2013 CPT codes relating to the specialty of Radiology. This commentary does not supplant the American Medical Association s current listing of CPT codes, its documentation in the annual CPT Changes publications, and other related publications from American Medical Association, which are the authoritative source for information about CPT codes. Please refer to your 2013 CPT Code Book, annual CPT Changes publication, HCPCS Book and Payer Bulletins for additional information, including additions, deletions, changes and s that may not be reflected in this document. CPT is a registered trademark of the American Medical Association ( AMA ). The AMA is the owner of all copyright, trademark and other rights to CPT and its updates. CPT codes, descriptions and other data are copyright 1966, 1970, 1973, 1977, 1981, American Medical Association. All rights reserved. 1

2 OVERVIEW Current Procedural Terminology (CPT) 2013 contains new and revised codes for a variety of diagnostic, interventional, nuclear medicine and radiation oncology procedures. Revenue Management Solutions (RMS), a division of McKesson, has prepared this summary to provide you with details on CPT code additions, deletions and modifications issued by the American Medical Association (AMA). PROCEDURAL CODE CHANGES With 2013 CPT there has been the addition of 186 new codes, 118 deleted codes, and 263 revised codes. In the 70,000 series, Diagnostic Radiology, there were a few changes, including five additions with nineteen deleted and fifteen revised codes. Some of those changes include the deletion of several supervision and codes related to aortography. For these codes the instructional note references the proper code selection to be in the series, where new codes appear, which includes radiological supervision and. As seen in previous years these new codes now include the catheter placement as well as imaging. There are also several instructional notes stating if the angiography is performed at the time of cardiac catheterization, you are to reference new the appropriate cardiac catheterization code(s) in the Medicine section of CPT. Additional instructional notes for transcatheter therapy procedures reference the use of codes for radiology supervision and. Additional verbiage is added to the 3D reconstruction codes which provide clarification that the image post processing must be performed under concurrent supervision. There are also five new codes appearing in the Nuclear Medicine section for Endocrine procedures. The code specifics will appear later in this document. DIAGNOSTIC RADIOLOGY There are a few changes to the Diagnostic Radiology section. These included the deletion of the bronchography codes, angiography codes and revision to a few spine codes and thrombolytic infusion codes. Also, note the addition of several parenthetical notes. This includes a note added to epidurography, which states this code is excluded with any pre-sacral spinal fusion procedures (22586, 0195T, 0196T, 0309T) The two bronchography codes for unilateral and bilateral have been deleted. If reported, the instructional note states to use code 76499, which is an unlisted CPT code. Since this is an unlisted code a copy of the dictated report will need to accompany the claim. Deleted Codes Bronchography, unilateral, radiological supervision and Bronchography, bilateral, radiological supervision and Interpretation 2

3 There are several codes that have a minimal descriptor change where the term or other qualified health care professional has been added. This is noted in the fluoroscopy codes as well as two ultrasound codes Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time, other than or (eg, cardiac fluoroscopy) Fluoroscopy (separate procedure), up to 1 hour physician, assisting a nonradiologic physician or other qualified health care professional (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy) Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health professional manipulation) Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other qualified health professional manipulation) The three cervical codes are revised to be specific to the number of views. The references to minimum number or complete have been removed. This change is a result of current clinical practices and more clearly defines the work performed Radiologic examination, spine, cervical; 3 views or less Radiologic examination, spine, cervical; 4 or 5 views Radiologic examination, spine, cervical; 6 or more views The clarification on the 3D reconstruction codes is confirmed by the American College of Radiology (ACR) Clinical Examples in Radiology that this service needs active physician involvement and monitoring as defined by concurrent physician supervision. Also the parenthetical note was revised to reflect changes which took place in the nuclear medicine codes d rendering with and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation ; Requiring image postprocessing on an independent workstation 3

4 Minor changes to the mammography computer-aided detection descriptors which only removes the reference to physician Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for, with or without digitization of film radiographic images; diagnostic mammography (List separately in addition to code for primary procedure) Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for, with or without digitization of film radiographic images; screening mammography (List separately in addition to code for primary procedure) RADIATION ONCOLOGY A new section has been added titled Stereotactic Radiation Therapy in which the instructional notes describe Thoracic stereotactic body radiation therapy (SRS/SBRT) and the target delineation. This new code is to be reported once per the patient s course of treatment. There is also a new category III code for the destruction/reduction of malignant breast tumors. Category III codes define new technologies and are used for data collection. Two instructional notes have been added, for Stereotactic body radiation therapy. Instructions state the same physician should not report both stereotactic radiosurgery services (32701, 63620, 63621) and radiation treatment management (77435). Under the Hyperthermia section instructional note for focused microwave thermotherapy of the breast states to use 0301T Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment 0301T 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. NUCLEAR MEDICINE Several of the changes, deletions and additions appear in the Nuclear Medicine section. Seven Thyroid codes have been deleted and replaced by three new codes which combine the single and multiple determinations. There is also a revision to the existing parathyroid imaging code, and two new codes added under this section. This change comes about due to the codes potentially being misvalued by the AMA/Specialty Society RVS Update Committee (RUC). This determination of their review was these codes would benefit from modernization and consolidation. 4

5 Deleted Codes Thyroid uptake; single determination Thyroid uptake; multiple determinations Thyroid uptake; stimulation, suppression or discharge (not including initial uptake studies) Thyroid imaging, with uptake; single determination Thyroid imaging, with uptake; multiple determinations Thyroid imaging; only Thyroid imaging; with vascular flow Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) Thyroid imaging (including vascular flow, when performed); Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) The previous single parathyroid planar imaging code had a descriptor change and will be broken out to three different codes. The old code of didn t reflect current clinical practice Parathyroid planar imaging (including subtraction, when performed); Parathyroid planar imaging (including subtraction, when performed); with tomographic SPECT Parathyroid planar imaging (including subtraction, when performed); with 5

6 tomographic SPECT, and concurrently acquired computed tomography (CT) for anatomical localization Noninvasive Vascular Diagnostic Studies There is only one addition to this section which again is a category III code, established for reporting noninvasive measurement of central arterial pressure waveforms (eg, arterial tonometry) 0311T Non-invasive calculation and analysis of central arterial pressure waveforms with and report. INTERVENTIONAL (IR) The most significant changes for 2013 are taking place within vascular procedures. There are new instructions for the eight new codes for diagnostic studies of cervicocerebral arteries. The new codes cover the selective and non-selective catheter placements of the carotid, innominate, subclavian and vertebral arteries. These are inclusive codes which include vessel access, catheterization, contrast, fluoroscopy, radiology supervision and, and closure, which lead to seven series angiography codes being deleted. Deleted Codes Angiography, external carotid, unilateral, selective, radiological supervision and Angiography, external carotid, bilateral, selective, radiological supervision and Angiography, carotid, cerebral, unilateral, radiological supervision and Angiography, carotid, cerebral, bilateral, radiological supervision and Angiography, carotid, cervical, unilateral, radiological supervision and Angiography, carotid, cervical, bilateral, radiological supervision and Angiography, vertebral, cervical, and/or intracranial, radiological supervision and 6

7 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, included angiography of the cervicocerebral arch, when performed 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, included angiography of the cervicocerebral arch, when performed 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, included angiography of the extracranial carotid and cervicocerebral arch, when performed Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and, included angiography of the extracranial carotid and cervicocerebral arch, when performed Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and, includes angiography of the cervicocerebral arch, when performed Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and, includes angiography of the cervicocerebral arch, when performed Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and (List separately in addition to code for primary procedure) 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 (eg, middle cerebral artery, posterior inferior cerebellar artery( )List separately in addition to code for primary procedure) 7

8 The current codes for foreign body retrieval have been combined also into a single code. The deletion of and and the newly created code are another result of the RUC review. Deleted Codes Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter) Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), radiological supervision and Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), included radiological supervision and, and imaging guidance (ultrasound or fluoroscopy), when performed. There are four new transcatheter thrombolytic Infusion codes. These also include the radiological supervision and. They also define if the treatment is the initial day or subsequent days. These new codes are reported once per date of treatments and for declotting by thrombolytic agents of an implanted vascular access device, or catheter, instructional notes state to use declotting by thrombolytic agent of implanted vascular access device or catheter. Deleted Codes Transcatheter therapy, infusion for thrombolysis other than coronary Exchange of a previously placed intravascular catheter during thrombolytic therapy Exchange of a previously placed intravascular catheter during thrombolytic therapy with contrast monitoring, radiological supervision and 8

9 Due to the addition of the new codes, existing codes needed to be revised to state that these codes are not an inclusive service and is reportable for thrombolysis procedures Transcatheter therapy, infusion, other than for thrombolysis, radiological supervision and Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis Trancatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and, initial treatment day Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and, initial treatment day Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and, continued treatment on subsequent day during course of thrombolytic therapy, including follow0up catheter contrast injection, position change, or exchange, when performed; ; Cessation of thrombolysis including removal of catheter and vessel closure by any method Non-Vascular Interventional Additional codes have emerged for thoracentesis which replace codes , and once again we see the imaging included in the primary procedure and is no longer reported separately. These new codes more accurately define the type of procedure being performed, thoracentesis vs drainage Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance Thoracentesis, needle or catheter, aspiration of pleural space; with imaging guidance 9

10 32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance Deleted Codes Pneumocentesis, puncture of lung for aspiration Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent Thoracentesis with insertion of tube, includes water seal (eg, for pneumothorax), when performed (separate procedure) The tube thoracostomy code has been revised to include connection to drainage system and is now an open procedure. Revised Code Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure) Code was added for chemodenervation of muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves. New Code Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine) 10

11 DISCLAIMER: This is an overview of the 2013 CPT/Modifier changes affecting the specialty of radiology. Please refer to your 2013 CPT Book, HCPCS Book and Payer Bulletins for additional information; HCPCS additions, deletions and changes are not reflected in this document. This publication is the or explanation of McKesson (RMS) and not necessarily the AMA s and not necessarily the position an agency checking the accuracy of coding would adopt. This publication is not intended to constitute legal, accounting, financial, investment or other professional advice. Your coding or business decisions should be made in consultation with your legal, professional and/or accounting advisors. Copyright 2013 PST, Inc. and/or one of its subsidiaries. All rights reserved. All other product or company names mentioned may be trademarks, service marks or registered trademarks of their respective companies. This publication is not intended to constitute legal, accounting, financial, investment or other professional advice. Any business decisions should be make in consultation with you personal legal, professional and accounting advisors. Current Procedural Terminology (CPT ) copyright: 2012 American Medical Association 11