Changes Ahead for Radiology Coders

Radiology coding professionals should welcome most of the 2019 procedure code changes, as many of them will simplify the reporting of radiology services and/or provide a way to report new services other than using an unlisted procedure code. We will review some of the most significant procedure code changes relevant to radiology.

Biopsy Codes

There are major revisions to the fine needle aspiration codes. Code 10022 (Fine needle aspiration; with imaging guidance) has been deleted, while code 10021 (Fine needle aspiration biopsy, without imaging guidance; first lesion) has been revised. The following codes have been added for additional lesions and for FNA with imaging guidance:

10004 Fine needle aspiration biopsy, without imaging guidance; each additional lesion (List separately in addition to code for primary procedure)
10005 Fine needle aspiration biopsy, including ultrasound guidance; first lesion
10006 . . . each additional lesion (List separately in addition to code for primary procedure)
10007 Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
10008 . . . each additional lesion (List separately in addition to code for primary procedure)
10009 Fine needle aspiration biopsy, including CT guidance; first lesion
10010 . . . each additional lesion (List separately in addition to code for primary procedure)
10011 Fine needle aspiration biopsy, including MR guidance; first lesion
10012 . . . each additional lesion (List separately in addition to code for primary procedure)

Fluoroscopy

Code 76001 (Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a nonradiologic physician or other qualified health care professional (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)) has been deleted for 2019.

Abdominal

Ultrasound Codes 76978 and 76979 have been established to describe a contrast ultrasound exam either of the liver for focal liver lesions or of the urinary tract in pediatric patients for vesicoureteral reflux. Previously, this exam was reported with deleted code C9744.

76978 Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion
76979 . . . each additional lesion with separate injection (List separately in additional to code for primary procedure)

Elastography

Elastography is a technique for evaluating tissue elasticity, or stiffness, often used to identify malignant tumors, as well as to diagnose conditions like fibrosis and cirrhosis that cause an organ to become more firm. Code +0346T [Ultrasound, elastography (List separately in addition to code for primary procedure)] has been deleted and replaced with codes 76981-76983. Code 76391 was also established for MR elastography.

76391 Magnetic resonance (eg, vibration) elastography
76981 Ultrasound, elastography; parenchyma (eg, organ)
76982 Ultrasound, elastography; first target lesion
+76983 . . . each additional target lesion (List separately in additional to code for primary procedure)

Breast MRI

Breast MRI codes 77058 and 77059 have been deleted and replaced with codes 77046-77049. Codes 7704677047 describe breast MRI without contrast. Codes 7704877049 describe breast MRI without and with contrast and include CAD, when performed.

77046 Magnetic resonance imaging, breast, without contrast material; unilateral
77047 . . . bilateral
77048 Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral
77049 . . . bilateral

Knee Arthrography

Code 27370 has been deleted and replaced with code 27369 (Injection procedure for contrast knee arthrography or contrast enhanced CT/MRI knee arthrography).

B-12 Absorption Study

Codes 78270-78272 for vitamin B-12 absorption studies, or the Schilling test, have been deleted as the test is now obsolete.

PICC Insertion and Replacement

Several revisions were made to the codes for peripherally inserted central venous catheter (PICC) insertion and replacement. Codes 36568 and 36569 have been revised to include “without imaging guidance,” codes 36572 and 36573 have been added, and code 36584 has been revised to include all imaging guidance and radiological S&I.

36568 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; without imaging guidance, younger than 5 years of age
36569 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; without imaging guidance, age 5 years or older
36572 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age
36573 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; age 5 years or older
36584 Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement

Additionally, the CPT® Manual states that midline catheters are not central venous access devices and cannot be reported with the codes for PICC services. Rather, midline catheter placement should be reported with the venipuncture codes (36400, 36405, 36406, and 36410).

G-Tube Replacement

The non-imaging gastrostomy tube replacement code (43760) has been deleted. Two new codes have been created for gastrostomy tube replacement without imaging. The codes differential whether revision of the gastrostomy tract is required.

43762 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract
43763 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract

Urinary Tract Dilation

The existing code for urinary tract dilation for nephrostomy track creation (50395) has been deleted and is being replaced by two new codes (50436-50437) that differentiate whether a new access is required. Radiological S&I code 74485 was revised to specify that the code only applies to the ureter(s) or urethra rather than a nephrostomy track.

Category III Codes

Ultrasound bone density measurement is a technique for measuring appendicular bone density using a portable ultrasound device that measures the cortical thickness of the tibia. This is coupled with other patient data to estimate the bone mineral density in the hip.

0508T Pulse-echo ultrasound bone density measurement resulting in indicator of axial bone mineral density, tibia

Code 0337T has been deleted. It was reported for endothelial function assessments.

HCPCS Level II Changes

The 2019 HCPCS Level II file is now available on the CMS website at: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html

The most significant HCPCS Level II changes are the changes to the breast MRI codes. The codes for MRI without contrast (C8904, unilateral and C8907, bilateral) have been deleted. Also, code C8937 [Computer-aided detection, including computer algorithm analysis of breast MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation (List separately in addition to code for primary procedure)] has been added for computer-aided detection for breast MRI.

Code C9744 (Ultrasound, abdominal, with contrast) has also been deleted for 2019.

- Article by Coding Strategies® Staff