ACR Radiology Coding Source™ September-October 2012
2013 CPT® Code Update
[The Health Insurance Portability and Accountability Act transaction and code set rules require the use of the medical code set that is valid at the time a service is provided. All billing systems should be updated and the new 2013 codes available for use as of January 1, 2013. There is no grace period to implement new code sets.]
Pertinent changes in the Current Procedural Terminology (CPT®) 2013 codebook that will affect radiology practices will be made and will require revision to computer systems and charge sheets. Most of the changes for 2013 are based on the CPT®/ Relative [Value Scale] Update Committee (RUC) Five-Year Review Identification Workgroup (now known as the Relativity Assessment Workgroup (RAW)) request to specialty societies to move forward with code changes to address code pairs reported together greater than 75 percent of the time and Harvard-valued codes with utilization greater than 30,000.
Diagnostic Radiology
[Revised] Cervical Spine Codes
72040 Radiologic examination, spine, cervical; three views or less
72050 four or five views
72052 six or more views
Because of confusion as to what constitute a completes study (72052) vs. minimum of four views (72050), editorial changes were requested to clearly define and accurately reflect the work performed by listing the number of views for the cervical spine codes.
[Deleted] Bronchography
71040 Bronchography, unilateral, radiological supervision and interpretation
71060 Bronchography, bilateral, radiological supervision and interpretation
The bronchography codes used in conjunction with bronchoscopy codes 31656 and 31715 will be deleted in 2013, as bronchography has been replaced by computed tomography. If bronchography is performed, code 76499, Unlisted diagnostic radiographic procedure, should be reported.
Interventional Radiology
[New] Thoracentesis and Pleural Drainage Codes
● 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)
(Do not report 32554-32557 in conjunction with 32550, 32551, 76942, 77002, 77012, 77021, 75989)
[Deleted] Pneumocentesis and Thoracentesis Codes
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)
Two of the three chest tube codes 32422 (Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure)) and 32551 (Tube thoracostomy, includes water seal (e.g., for abscess, hemothorax, empyema), when performed (separate procedure)) were identified as Harvard-based codes with a utilization greater than 30,000. Before resurveying as requested by the RAW, the specialty societies requested that these services be referred to the CPT Editorial Panel to modify the coding structure to describe current practice. Four new codes (32554, 32555, 32556, and 32557) were created to describe thoracentesis and pleural drainage with and without imaging. Moderate sedation is not included in these new procedure codes, and should be separately reported when appropriate.
Code 32551, Tube thoracostomy, includes water seal (eg, for abscess, hemothorax, empyema), when performed, will be revised to describe an open procedure, and no longer used to describe a percutaneous chest tube placement. Code 32551 will be used to describe a surgically placed chest tube involving an "actual" thoracostomy (incision and dissection extending through the parietal pleura), as opposed to a typical percutaneous tube placement performed by a radiologist.
The current codes 32420-32422 will be deleted in 2013.
[New] Cervicocerebral Artery Studies
ʘ● 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
(Do not report 36221 in conjunction with 36222-36226)
ʘ● 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
ʘ● 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
ʘ● 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
ʘ● 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
ʘ● 36226 Selective catheter placement, 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
ʘ● +36227 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)
(Use 36227 in conjunction with 36222, 36223 or 36224)
ʘ● +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 (eg, middle cerebral artery, posterior inferior cerebellar artery) (List separately in addition to code for primary procedure)
(Use 36228 in conjunction with 36224 or 36226)
(Do not report 36228 more than twice per side)
[Deleted] Cervicocerebral Angiography Codes
75650 Angiography, cervicocerebral, catheter, including vessel origin, radiological supervision and interpretation
75660 Angiography, external carotid, unilateral, selective, radiological supervision and interpretation
75662 Angiography, external carotid, bilateral, selective, radiological supervision and interpretation
75665 Angiography, carotid, cerebral, unilateral, radiological supervision and interpretation
75671 Angiography, carotid, cerebral, bilateral, radiological supervision and interpretation
75676 Angiography, carotid, cervical, unilateral, radiological supervision and interpretation
75680 Angiography, carotid, cervical, bilateral, radiological supervision and interpretation
75685 Angiography, vertebral, cervical, and/or intracranial, radiological supervision and interpretation
Eight new cervicocerebral angiography codes (36221-36228) to describe arterial nonselective and selective catheter placement and diagnostic imaging of the aortic arch, carotid and vertebral arteries, as well as new guidelines, were recommended for 2013. The carotid angiography codes were recommended for bundling as they were identified as high frequency code pairs performed together greater than 75 percent of the time. The cervicocerebral angiography radiological supervision and interpretation codes 75650, 75660, 75662, 75665, 75671, 75676, 75680, and 75685 will be deleted, as these services are bundled into the new comprehensive codes. The new codes include the work of accessing the vessel, placement of catheter(s), contrast injection(s), fluoroscopy, radiological supervision and interpretation, and closure of the arteriotomy by pressure, or application of an arterial closure device, and describe arterial contrast injections with arterial, capillary, and venous-phase imaging, when performed.
Detailed introductory guidelines were developed and placed in the CPT 2013 codebook prior to the 36221-36228 code section. Specific examples of reporting are provided. Codes 36222-36224 and 36225-36226 are built on a progressive hierarchy, with the less intensive services included in the more intensive services. As noted in the CPT 2013 codebook, 3D rendering (76376 or 76377) and ultrasound guidance for vascular access (76937) when performed in conjunction with 36221-36228 are reported separately. It is not appropriate to report 75774 (Angiography, selective, each additional vessel studied after basic examination, RS&I) when performed as part of a diagnostic angiography procedure of the extracranial and intracranial cervicocerebral vessels. However, it may be appropriate to report 75774, in addition to the appropriate base codes for those additional areas studied, when performed as a diagnostic angiography study of the upper extremities and other vascular beds performed in the same session.
Add-on code 36228 is reported in conjunction with the internal carotid artery (36224) and vertebral artery (36226) codes for each additional intracranial branch of the internal carotid or vertebral arteries. This code should not be reported more than twice per side.
Bilateral carotid and/or vertebral arterial catheterization and imaging is reported with the bilateral modifier 50. When a different territory (ies) is studied in the same session on both sides of the body, a modifier 59 (distinct procedural service) should be reported to designate that different carotid and/or vertebral arteries are being studied.
As noted by the bull’s eye preceding the code number, moderate sedation is included in the new procedure codes as well and should not be reported separately.
[New] Retrieval of Foreign body
ʘ● 37197 Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter, includes RS&I and imaging guidance (ultrasound or fluoroscopy), when performed
[Deleted] Foreign Body Retrieval Codes
37203 Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter) (use 37197)
75961 Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), radiological supervision and interpretation
Intravascular foreign body retrieval codes 37203 and 75961 were identified as being reported together greater than 75 percent of the time and, therefore, a new bundled code was recommended for 2013. Code 37197 bundles in imaging. Selective catheterization and diagnostic angiography are still reported separately. Moderate sedation is included, as denoted by the bull’s eye, and is not reported separately.
[New] Thrombolysis Codes
ʘ● 37211 Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day
ʘ● 37212 Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day
ʘ● 37213 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed;
ʘ● 37214 cessation of thrombolysis including removal of catheter and vessel closure by any method
(Report 37211-37214 once per date of treatment)
(For declotting by thrombolytic agent of implanted vascular access device or catheter, use 36593)
[Deleted] Thrombolysis
37201 Transcatheter therapy, infusion for thrombolysis other than coronary (see 37211-37214)
37209 Exchange of a previously placed intravascular catheter during thrombolytic therapy
75900 Exchange of a previously placed intravascular catheter during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation
Transcatheter therapy infusion for thrombolysis (other than coronary) codes 37201 and 75896 were identified as being reported together greater than 75 percent of the time. Codes 37211-37214 will replace code 37201. Imaging will be bundled into the procedure codes in 2013, as noted in the descriptor.The cross-references following the associated imaging codes 75896 (Transcatheter therapy, infusion, any method (eg, thrombolysis other than coronary) for thrombolysis, radiological supervision and interpretation) and 75898 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis) will note that it is not appropriate to report these codes in conjunction with the new thrombolysis codes 37211-37214. The current thrombolysis codes 37201, 37209, and 75900 will be deleted in 2013.
The initial day of transcatheter thrombolytic arterial or venous infusion(s) including follow-up arteriography/venography, and catheter position change or exchange, when performed, are described by codes 37211 and 37212 respectively. As noted in the CPT codebook, a bilateral thrombolytic infusion through a separate access site(s) should be reported using the bilateral modifier 50. However, use of modifiers is carrier dependent. Please check with local payers for specific guidelines on the use of modifiers. Continued transcatheter thrombolytic infusion(s) on subsequent day(s), other than initial day and final day of treatment, is reported with code 37213. The final day of transcatheter thrombolytic infusion(s) is reported with code 37214. Initiation and completion of thrombolysis performed on the same day is reported by 37211 or 37212. Catheter placement(s), diagnostic studies, and other percutaneous interventions (eg, transluminal balloon angioplasty, stent placement) performed are reported separately.
Fluoroscopic guidance and associated radiological supervision and interpretation, the exchange of a previously placed intravascular catheter during thrombolytic therapy, and moderate sedation are bundled into the new transcatheter therapy codes. Note, however, ultrasound guidance for vascular access, when performed, is reported separately with code 76937.
As noted in the introductory guidelines of the CPT 2013 codebook, ongoing evaluation and management services on the day of the procedure related to thrombolysis are included. Only when a significant, separately identifiable E/M service is performed by the same physician on the same day of the procedure, should the appropriate level of E/M service be reported with a modifier 25 (Significant, separately identifiable evaluation and Management service by the same physician on the same day of the procedure or other service) appended.
Nuclear Medicine
[New] Endocrine and Parathyroid
● 78012 Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)
● 78013 Thyroid imaging (including vascular flow, when performed);
● 78014 with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)
● 78071 Parathyroid planar imaging (including subtraction when performed); with tomographic (SPECT)
● 78072 with tomographic (SPECT) and concurrently acquired computed tomography (CT) for anatomical localization
[Revised] Parathyroid Code
78070 Parathyroid planar imaging (including subtraction when performed);
[Deleted] Endocrine Codes
78000 Thyroid uptake; single determination
78001 Thyroid uptake; multiple determinations
78003 Thyroid uptake; stimulation, suppression or discharge (not including initial uptake studies)
78006 Thyroid imaging, with uptake; single determination
78007 Thyroid imaging, with uptake; multiple determinations
78010 Thyroid imaging; only
78011 Thyroid imaging; with vascular flow
The nuclear medicine thyroid code 78007, Thyroid imaging, with uptake; multiple determinations, was identified as a Harvard-valued code with utilization greater than 30,000. Before submitting this code to the RUC for revaluation, the specialty societies requested that the CPT Editorial Panel review the code structure for the thyroid and parathyroid codes to appropriately describe the types of procedures as performed in current practice. It was recommended that the current seven thyroid codes be deleted and replaced with three new codes (78012, 78013, 78014) to describe thyroid uptake and imaging procedures. Also, it was recommended that the existing parathyroid code 78070 be revised to specify planar imaging and that subtraction is included when performed. In addition, two new codes (78071, 78072) were created to describe parathyroid planar imaging with tomographic SPECT, and parathyroid planar imaging with tomographic SPECT and CT for anatomic localization.
Radiation Oncology
[New] Stereotactic Body Radiation Therapy Code
● 32701 Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment
A new code was added to the Surgery/Respiratory section of the CPT 2013 codebook under Stereotactic Radiation Therapy for use by surgeons/physicians to describe the work of determining tumor borders to identify tumor volume, relationship with adjacent structures (eg, chest wall) and availability of the surgeon to identify and validate the thoracic target prior to treatment delivery when a fiducial-less tracking system is utilized. When performed in collaboration with a radiation oncologist, the radiation oncologist reports the code(s) for clinical treatment planning, physics and dosimetry, treatment delivery and management from the Radiation Oncology code section of the CPT codebook. Currently, surgeons/physicians are using the unlisted code 32999 to describe this service.
As noted in the CPT 2013 codebook, code 32701 should not be reported more than once per entire course of treatment when the treatment requires greater than one session, and should not be reported in conjunction with the radiation oncology codes 77261-77799, or with 31626 or 32553 for the placement of fiducial markers.
Category III Code Changes
[New] Focused Microwave Ablation Code
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
(Do not report 0301T in conjunction with 76645, 76942, 76998, 77600-77615)
Code 0301T was effective for use on July 1, 2012 and is now listed in the CPT 2013 codebook.
[Extended] CAD and HDR Brachytherapy Codes
0174T Computer-aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed concurrent with primary interpretation (List separately in addition to code for primary procedure)
0175T Computer-aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed remote from primary interpretation
0182T High dose rate electronic brachytherapy, per fraction
The chest radiography computer-aided detection codes and high dose rate electronic brachytherapy codes were extended and will not be sunset until 2017, as it is believed that they will eventually be eligible for Category I code status.
Category III codes are used primarily for tracking new procedures and are not referred to the AMA Relative Value Scale Update Committee for valuation. However, they are carrier priced if the service is covered. Updates are posted biannually (January and July) and are effective six months after posting. This delay provides time for providers/payers to update systems. These codes are maintained until they meet Category I code requirements or they are archived after five years unless a further need is demonstrated to maintain the Category III code status. Click here for more detailed information on CPT® Category I, II and III codes.
Other
Please refer to the CPT 2013 codebook for a complete listing of new and revised CPT® 2013 codes and guidelines. Numerous parenthetical revisions have been made, as well as additional code changes not detailed here. It is important to update your CPT codebook each year to ensure you are using the most current codes. Also refer to the Fall 2012 AMA/ACR’s Clinical Examples in Radiology Bulletin for a crosswalk to the new 2013 radiology codes, as well as the Winter 2013 and future Clinical Examples issues for detailed discussions on the reporting of these new codes.
References:
AMA’s CPT changes 2013: An Insider’s View.
AMA 2013 CPT Current Procedural Terminology, Professional Edition.