CPT 2018 Anticipated Code Changes

Diagnostic Radiology

Chest X-ray Codes

Chest X-ray codes 71010, 71015, 71020, 71021, 71022, 71023, 71030, 71034, and 71035 will be deleted and four new codes created to report chest X-ray procedures described by the number of views vs. view-specific descriptors.

Chest X-ray codes were identified in the 2016 Medicare Physician Fee Schedule (MPFS) Notice of Proposed Rule Making, Potentially Misvalued Codes Identified through High Expenditure by Specialty Screen. After the Relative Value Scale Update Committee’s (RUC) mandate to revise these codes, the ACR requested an update in the descriptor language in order to increase the flexibility and accuracy for coding customized exams, which currently are coded with view-specific descriptors.

Abdominal X-ray Codes

Abdominal X-ray codes 74000, 74010 and 74020 will be deleted and three new codes added to report abdominal X-ray procedures described by the number of views vs. view-specific descriptors. Abdominal X-ray codes 74000 and 74022 also were identified in the 2016 MPFS Notice of Proposed Rule Making, Potentially Misvalued Codes Identified through High Expenditure by Specialty Screen. Similar to the chest X-ray codes, it is anticipated that the recommended changes will increase the flexibility and accuracy for coding customized exams, which currently are coded with view-specific descriptors.

Interventional Radiology

Cryoablation Treatment of Pulmonary Tumors

Look for a new CPT Category I code to replace Category III code 0340T, Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance, as well as revision to code 32998, Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s)… to include imaging for ablation of tumor.

Endovascular Repair Infrarenal Aorta

The RAW identified codes 34802, 34812, 34825 used to report endovascular repair of abdominal aortic aneurysms (EVAR), and some EVAR codes that may be billed frequently with other codes, for revision. Look for a number of new bundled codes and revision to existing EVAR codes to demonstrate the most common application and the addition of codes to represent adjunctive procedures that may be performed with EVAR.

With the establishment of new codes, codes 34800-34806, 34825, 34826, 34900, 75952-75954, 93982, 0255T are proposed for deletion and code 0254T is to be revised.

Detailed guidelines on what can be reported separately will be provided in the introductory guidelines.

Endovenous Ablation of Incompetent Veins

New codes will be established for the reporting of endovenous ablation therapy of incompetent veins using a chemical adhesive. Revision of injection codes 36468, 36470, and 36471 will be made to distinguish treatment of spider veins and incompetent veins for telangiectasia and for diagnoses other than telangiectasia.

In addition, look for new codes to be created for reporting the injection of a non-compounded foam sclerosant for treatment of incompetent veins.

Bone Marrow Diagnostic Procedures

A new code will be created to describe a diagnostic bone marrow procedure that bundles biopsy and aspiration into one code. Currently, there are Correct Coding Initiative edits that do not allow the reporting of both procedures. In addition, codes 38220, Bone marrow; aspiration only and 38221, Bone marrow; biopsy, needle or trocar will be revised to specify that these are diagnostic studies.

Brachial Retrograde Artery Introduction of Needle or Catheter

Look for angiography codes 36120 and 75658 to be deleted as these services are more appropriately reported with other existing upper extremity angiography codes. With the deletion of code 36120, code 36140, Introduction of Needle or catheter, brachial retrograde artery, will be revised to describe upper or lower extremity and will become a stand-alone code.

Radiation Oncology

Transperineal Placement of Biodegradable Material

Look for a new CPT Category I code with revised descriptor to replace Category III code 0438T, Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance.

Code 77422 Marked for Deletion

Code 77422, High energy neutron radiation treatment delivery; single treatment area using a single port or parallel-opposed ports with no blocks or simple blocking, will be deleted due to low utilization.

Through the efforts of ACR and others, the high energy neutron radiation treatment delivery code77423 will be retained and not deleted as had been suggested.

Nuclear Medicine

Code 78190, Kinetics, study of platelet survival, with or without differential organ/tissue localization, will be deleted due to low utilization.

Category III Codes

To Be Deleted

0255T Endovascular repair of iliac artery bifurcation (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using bifurcated endoprosthesis from the common iliac artery into both the external and internal iliac artery, unilateral; radiological supervision and interpretation
[Coders will be referred to code 0254T.]

To Be Converted to Category I Code Status

0340T Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance

0438T Look for a new CPT Category I code with revised descriptor to replace Category III code 0438T, Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance.

To Be Revised

0254T Endovascular repair of iliac artery bifurcation (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using bifurcated endoprosthesis from the common iliac artery into both the external and internal iliac artery, unilateral will be revised to bundle in all radiological supervision and interpretation.
To Be Extended:

042T Cerebral perfusion analysis using computed tomography with contrast administration, including post-processing of parametric maps with determination of cerebral blood flow, cerebral blood volume, and mean transit time.

This summer the Economics & Health Pollicy eNews section of the ACR website will post an impact analysis of the 2018 code changes to help radiology and radiation oncology practices prepare for the 2018 changes. In addition, the September/October 2017 issue of the ACR Radiology Coding Source will include a list of the new 2018 codes and descriptors pertinent to radiology.

The AMA will provide an early release of a downloadable version of the CPT® 2018 code book from the AMA Bookstore in August. The CMS-approved values for codes, however, will not be known until the Medicare Physician Fee Schedule Final Rule is published in the Federal Register, typically in November.

Be sure to check out the complete listings of code changes in the AMA’s CPT 2018 code book.

Note
The AMA posts a Summary of Panel Actions that is available for public viewing. While this summary lists the code changes proposed and the actions taken by the panel, the AMA cautions that these actions are a reflection of the discussions at the most recent CPT Editorial Panel meeting. Future Panel actions may impact these items. Codes are not assigned, nor exact wording finalized, until just prior to publication. Release of this more specific CPT^® code set information is timed with the release of the entire set of coding changes in the CPT publication.