Changes Coming Your Way in 2019

Anticipated radiology CPT® changes for 2019 are discussed in the March-April issue of the ACR Radiology Coding Source™. We’ll give you a brief summary in this article, but please see the ACR website for complete information:

Many of these changes are a result of the work by the AMA’s Relativity Assessment Workgroup (RAW) in identifying potentially misvalued services.

More information on the code changes will appear in the Spring Bulletin of the AMA/ACR Clinical Examples in Radiology. However, keep in mind that changes are not final until the AMA releases the new code set in August, and the CPT® Editorial Panel may make additional changes between now and then.

Fine needle aspiration code 10021 will be revised and code 10022 will be deleted. Also, 9 new codes that bundle the procedure and radiological supervision and interpretation (S&I) will be added.

Codes 77058, 77059, and 0159T will be deleted and replaced with 4 new breast MRI codes – 2 codes for breast MRI with and without contrast, and 2 codes that bundle computer-aided detection (CAD). Therefore, the breast MRI with CAD will be reported with Category I codes rather than Category III codes. Code 27370 (injection of contrast for knee arthrography) is likely being incorrectly reported as arthrocentesis or aspiration.

Code 27370 is expected to be deleted and replaced with a new code to report the injection procedure for knee arthrography or CT/MRI knee arthrography.

Ultrasound elastography Category III code 0346T is proposed to be deleted, and 3 new Category I codes will be added and will distinguish reporting per organ, first target lesion, and each additional target lesion.

There is currently no CPT code to describe magnetic resonance elastography as it is a new technology. A new code is proposed to be added to report this service.

Two new codes will be added to report ultrasound procedures that use dynamic microbubble-sonographic contrast with targeted ultrasound in evaluating lesions (contrast enhanced-ultrasound or CEUS).

Fluoroscopy code 76001 is set to be deleted to due low utilization of the code since this service is rarely performed and to minimize concerns of miscoding.

Two new codes will be added to describe PICC line procedures that bundle imaging guidance, imaging documentation, and all associated radiological S&I. Introductory language and parentheticals will also be updated to reflect that codes 36568 and 36569 are used to report PICC placement without imaging guidance. Code 36548 will be revised to include imaging guidance, imaging documentation, and all associated radiological S&I. The guidelines in the CPT codebook will also be updated.

RAW determined that code 43760 is reported by many different specialists and providers. To address the differences in physician work, code 43760 will be deleted and replaced with 2 new codes that define replacement of a percutaneous gastrostomy tube as simple or complex.

Two new codes are expected to report dilation of the urinary tract for endourologic procedures. Code 50395 will be deleted. Guidelines for the new codes will be added in the introduction of the urinary system section of the CPT codebook.

A new Category III code is expected to be available to report pulse-echo ultrasound bone density measurements for bone mineral density analysis.

For PET for the absolute quantification of myocardial blood flow at rest and at stress, a new Category III code has been proposed.

Five new patient relationship modifiers are proposed for development under the Merit-based Incentive Payment System (MIPS). These modifiers will attribute a patient to the physician(s) who is responsible for particular services to assess the resource use and episode of care for the MIPS Cost performance category.

- Article by Coding Strategies® Staff