CPT 2015: Prepare Your Coding Practice For New Codes As Technology Makes An Advance

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1 2015 Radiology Coding Survival Guide Section X : 2015 Coding Updates CPT 2015: Prepare Your Coding Practice For New Codes As Technology Makes An Advance Watch for changes in Vertebral fracture assessment, breast imaging, vertebroplasty procedures. The CPT radiology coding changes for 2015 are available now. These changes become effective January 1, Here are highlights of what changes you need to introduce in your practice next year. Prepare in advance and safeguard your reimbursements. Check Bone Density Study with Vertebral Fracture Assessment Currently, you bank upon (Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; vertebral fracture assessment) for vertebral fracture assessment. Effective 2015, this code will no longer be valid. You have two new codes for vertebral fracture assessment. These include (Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine], including vertebral fracture assessment) where vertebral fracture assessment is done as part of bone density study and (Vertebral fracture assessment via dual-energy X-ray absorptiometry [DXA]) which is for vertebral fracture assessment alone. This is in keeping with the trend to clarify and increase specificity in coding. Include New Codes for Breast Ultrasound and Digital Tomosynthesis Make note of two new codes for breast ultrasound. These include the following: 76641, Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete 76642, Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited Also add the following three codes for breast tomosynthesis to your list: 77061, Digital breast tomosynthesis; unilateral 77062, Digital breast tomosynthesis; bilateral 77063, Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure) These codes help to ensure your payment for use of new imaging technologies. New codes continue to be developed to keep up with new technologies, Midkiff says. Avoid Confusion in Myelography Codes You will spot new myelography codes in 2015 which include the supervision and interpretation. They are: 62302, Myelography via lumbar injection, including radiological supervision and interpretation; cervical 62303, Myelography via lumbar injection, including radiological supervision and interpretation; thoracic 62304, Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral 62305, Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (e.g., lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical) Catch the paradox: The codes and seem to represent the injection portion of the procedure. You may find it challenging to decide which of these is the most appropriate code. In this case, it will be best for you to confirm with your payer.

2 Revision: Note that the existing code for myelogram injection, (Injection procedure for myelography and/or computed tomography, spinal [other than C1-C2 and posterior fossa]) has been revised. The revision is as follows: 62284, Injection procedure for myelography and/or computed tomography, lumbar. Look for New Options for Vertebroplasty/Kyphoplasty If you re regularly reporting vertebroplasty and kyphoplasty procedures, then you should take note of CPT 2015 s dramatic changes. The existing codes have been deleted, and now you ll find new codes specifying imaging guidance. What happens: Both percutaneous vertebroplasty and kyphoplasty involve percutaneous injection of methylmethacrylate under imaging guidance (either fluoroscopy or CT) into a cervical, thoracic, or lumbar vertebral body lesion. Kyphoplasty also involves placement of a balloon catheter to reduce the fracture and then inject biomaterial into the cavity. The new codes are: Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic lumbosacral each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure) Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic lumbar each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) It s important to see that the new vertebroplasty code, 22510, also includes the cervical spine region. If a provider performs a cervical vertebroplasty in 2014, you can only report it with (Unlisted procedure, spine). It will be good that pain management providers will be able to report the cervical procedure with the new code. Each of the codes also includes the bulls-eye symbol designation, which means the associated RVUs and service include moderate sedation. This is new for kyphoplasty in The 2014 codes ( ) did not include moderate sedation, so you could bill it separately. The deleted codes are: Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic lumbar each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic lumbar each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) Heads up: Because of the updated descriptors, the associated radiology codes for guidance will be deleted. You ll no longer be able to report the following codes as part of your vertebroplasty or kyphoplasty claim: Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance under CT guidance. Exception: You do not see a specific code for sacroplasty. If your physician does a sacral vertebroplasty then you will have two Category III codes to report that includes imaging guidance: 0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or

3 mechanical device, when used, 1 or more needles,includes imaging guidance and bone biopsy, when performed 0201T Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles,includes imaging guidance and bone biopsy, when performed. Also: Look for the inclusive imaging guidance in these codes. Another trend in coding is bundling the imaging guidance, reducing component coding, and potentially RVUs, says Midkiff. Editor s note: Stay tuned for more CPT 2015 information in upcoming issues of the Radiology Coding Alert. CPT 2015: Watch For Codes With Ultrasound and Imaging Guidance Inclusions You ll also need to update interventional radiology and RSA codes. Specify Whether Joint Aspiration Included U/S Guidance In 2015, you will find new codes for joint aspiration and/or injection which include ultrasound guidance. In addition, the existing codes will be revised to state without ultrasound guidance. You ll choose new and revised codes for arthrocentesis depending upon whether or not your physician used ultrasound guidance. The new and revised codes (with changes reflected) are the following: Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); small joint or bursa (eg, fingers, toes)without ultrasound guidance (new) with ultrasound guidance, with permanent recording and reporting Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa);intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)without ultrasound guidance (new) with ultrasound guidance, with permanent recording and reporting Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)without ultrasound guidance (new) with ultrasound guidance, with permanent recording and reporting Note: These six codes will represent the services based on the number of vertebral bodies your physician treated and the spinal area. Each code will continue to represent both unilateral and bilateral injections. What happens: Arthrocentesis, also known as joint aspiration, is the clinical procedure in which the fluid from within the joint is removed using a needle and syringe. The skin over the aspiration site is cleaned with an antiseptic liquid. The physician then pushes a needle through the skin and into the joint and then removes the fluid with the help of a syringe attached to the needle. After the aspiration, the fluid sample may be sent to the laboratory for further examination. Watch out: Sometimes you ll see your physician performing these procedures with fluoroscopic guidance, which the new codes do not address. This section of changes can get a little confusing because according to the ACR when fluoroscopicguided arthrocentesis is performed component coding should still be used. This means guidance is a huge factor in coding these procedures and coders need to be careful to not forget to code fluoro separately when it is used instead of ultrasound guidance. Renew Intravascular Stent Coding CPT 2015 revises (Transcatheter placement of intravascular stent[s] ) to clean up some wording and clarify that the procedures include angioplasty, when performed, and also include radiological supervision and interpretation. The changes made to and make them more consistent with all other endovascular bundled coding.

4 The changes read as follows (see underlined): 37215, Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection 37216, Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protection Look for a new code: Along with those revisions, you ll also have a new CPT code for placement of intrathoracic common carotid or innominate artery stent. This code includes angioplasty and imaging. In 2015, you will report (Transcatheter placement of intravascular stent[s], intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation) for intrathoracic common carotid or innominate artery stenting. As outlined in the 2015 CPT book, code is to be used in conjunction with 36216, 36217, 36225, and For angiography, the book directs you to code , , and For angioplasty, the book directs you to and Remember: Do not report for cranial or cerebral vessels. The ACR states that or should NOT be reported as part of diagnostic angiography of the extracranial and intracranial cervicocerebral vessels. They then go on to say that it may be appropriate to code and for diagnostic angiography of upper extremities and other vascular beds of the neck and/or shoulder girdle performed in the same session as vertebral angiography. The changes in code descriptor for are marked below , Ablation therapy for reduction or eradication of 1 or more bone tumor(s) tumors (e.g., metastasis),radiofrequency including adjacent soft tissue when involved by tumor extension, percutaneous,including imaging guidance when performed; radiofrequency In addition, you will have a new code that has been added for cryoablation of bone tumors. The new code is (Ablation therapy for reduction or eradication of 1 or more bone tumors [e.g., metastasis] including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; cryoablation). Ablation therapy for pulmonary tumors: In 2015, you have a new category III code for cryoablation of pulmonary tumors. Add code 0340T (Ablation, pulmonary tumor[s], including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance) to your list of ablation therapy codes in Replenish Your Practice with New RSA Codes What is Radiostereometric analysis? Radiostereometric Analysis (RSA) is method for measuring micromotions in the skeleton with high precision using small spherical markers made of tantalum. Your physician may insert the markers in the patient s body either surgically or non-surgically by using an insertion device. Then your physician obtains simultaneous X- rays from two angles. Finally, your physician measures the marker projections on the film and constructs threedimensional coordinates. The motion between different segments is calculated by comparing with results from previous RSA. List 3 new codes: In 2015, you will have three new category III codes for RSA. Depending upon whether your physician does RSA in the spine, upper or lower limb, you select from the following codes; 0348T, Radiologic examination, radiostereometric analysis (RSA); spine, (includes cervical, thoracic and lumbosacral, when performed) 0349T, Radiologic examination, radiostereometric analysis (RSA); upper extremity(ies), (includes shoulder, elbow, and wrist, when performed) 0350T, Radiologic examination, radiostereometric analysis (RSA); lower extremity(ies), (includes hip, proximal femur, knee, and ankle, when performed)

5 CPT 2015: Prepare Now for New Vertebroplasty and Kyphoplasty Code Choices in 2015 Plus: Don t miss these spinal myelography updates. Some of your spinal coding will change quite a bit in January once CPT 2015 goes into effect. Here s your scoop on what to expect from updates to joint injections, vertebroplasty, kyphoplasty, and more. Watch for Kyphoplasty, Vertebroplasty Code Overhaul You ll be reporting kyphoplasty and percutaneous vertebroplasty services differently in 2015, thanks to six new codes that will represent the services based on the number of vertebral bodies treated and the spinal area. Note that each code will continue to represent both unilateral and bilateral injections: Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic lumbosacral each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure) Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (e.g., kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic lumbar each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure). It s important to see that the new vertebroplasty code, 22510, also includes the cervical spine region. If a provider performs a cervical vertebroplasty in 2014, you can only report it with (Unlisted procedure, spine). It will be good that pain management providers will be able to report the cervical procedure with the new code. These codes will replace your current options, The biggest change is the addition of inclusive of all imaging guidance to the descriptors. Each of the new codes also includes the bulls-eye symbol designation, which means the associated RVUs and service include moderate sedation. This is new for kyphoplasty in The 2014 codes ( ) did not include moderate sedation, so you could bill it separately. Because of the updated descriptors, the associated radiology codes for guidance will be deleted. You ll no longer be able to report the following codes as part of your vertebroplasty or kyphoplasty claim: Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance under CT guidance. Pay Attention to Region for Spinal Myelography Spinal myelography codes also undergo changes that will help you code procedures in more detail. Existing code (Injection procedure for myelography and/or computed tomography, spinal [other than C1-C2 and posterior fossa]) will be revised to represent the lumbar area rather than its current, wider range spinal designation. The new descriptor will read, Injection procedure for myelography and/or computed tomography, lumbar. You ll also have four new code choices for myelography via lumbar injection: Myelography via lumbar injection, including radiological supervision and interpretation; cervical thoracic lumbosacral or more regions (e.g., lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical). Note that three of the codes specify spinal region (cervical, thoracic, or lumbar) and the fourth represents the procedure in two or more regions (lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical).

6 Also: You ll report the new codes if the same physician performs both the myelogram injection and the interpretation of the diagnostic study. If two different physicians perform the different components, however, you ll submit for the injection. The physician completing the radiologic supervision and interpretation of the report will choose from Focus on Guidance for Joint Injections Changes to joint injection codes will specify whether the physician used ultrasound guidance during the procedure. The current codes (20600, 20605, and 20610) will be revised to specify without ultrasound guidance, and you ll have three new codes for the same injections using US guidance. The new codes are: Arthrocentesis, aspiration and/or injection, small joint or bursa (e.g., fingers, toes); with ultrasound guidance, with permanent recording and reporting Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting. Check When Chronic Care Management Might Apply CPT 2013 introduced three new codes for complex chronic care coordination services (99487, 99488, and ). CPT 2015 expands on this concept by adding two codes for chronic care management services: Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: o multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, o chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, o comprehensive care plan established, implemented, revised, or monitored each additional 30 minutes (List separately in addition to code for primary procedure). Without having additional information on what would be required to report these services, it s hard to determine the differences between the revised codes and new codes. The primary difference that I initially see is the term complex in the revised codes whereas the new codes are just chronic care management. It will be interesting to see what additional information coders will get to help differentiate between the two groups of codes. - Published on