December 2016

Radiology Billing and Coding: CPT 2017 Updates for Radiology
By G. John Verhovshek, MA, CPC
Radiology Today
Vol. 17 No. 12 P. 6

Every autumn, the American Medical Association releases a revised CPT code set for use beginning the following January. Here's a rundown of changes affecting the 70000-series of codes (Radiology) in 2017.

New Surgical Angio Codes Bundle Radiology Supervision and Interpretation
Over the past several years, CPT has eliminated separate coding for many radiological services by creating new and replacement surgical codes that include any associated radiological supervision and interpretation (S&I) or guidance. The same occurs in 2017 with the introduction of nine cardiovascular codes (36901-36909) under the new heading "Dialysis Circuit." For example, new code 36904 specifies, "Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s)." As a result, six radiology codes that previously described separately reported angiography/angioplasty services (75791, 75962, 75964, 75966, 75968, and 75978) are deleted.

Added parenthetical instructions in CPT now direct as follows:
• For radiological S&I of dialysis circuit angiography performed through existing access or catheter-based arterial access, use (new code) 36901 (Introduction of needle[s] and/or catheter[s], dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture[s] and catheter placement[s], injection[s] of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation, and image documentation and report) with modifier 52, Reduced services.

• For radiological supervision and interpretation of transluminal balloon angioplasty within the peripheral and/or central segments of a dialysis circuit performed through the dialysis circuit, see 36902, 36905, and/or 36907.       

Mammography Codes Are Completely Overhauled
Mammography codes are overhauled and condensed. Five codes (77051, 77052, 77055, 77056, and 77057) are deleted and replaced by the following three new codes:

• 77065, Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral reports unilateral diagnostic mammography.

• 77066, Diagnostic mammography, including CAD when performed; bilateral describes bilateral diagnostic mammography.

• 77067, Screening mammography, bilateral (2-view study of each breast), including CAD when performed describes bilateral diagnostic mammography with 2-view study of each breast.

Each of the new codes includes CAD, when performed, to aid in breast cancer detection.

For electrical impedance breast scan, CPT instructs us to report unlisted procedure code 76499, Unlisted diagnostic radiographic procedure.

Two Fluoroscopic Services Become Add-ons
Codes 77002, Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (list separately in addition to code for primary procedure), and 77003, Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (list separately in addition to code for primary procedure), become designated "add-on" codes. Beginning January 1, 77002 and 77003 may be reported only in addition to designated primary codes (ie, neither code may "stand alone" as an independently billed service).

CPT parenthetical instructions provide a full listing of primary codes with which you may report 77002 and 77003 (eg, Use 77003 with 61050 Cisternal or lateral cervical [C1-C2] puncture; without injection [separate procedure], etc.). Additionally, a new parenthetical instructs, "do not report 77003 in conjuction with [injection codes] 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327." The injections include imaging guidance, when provided.

New AAA Ultrasound Code
CPT 2017 adds a new code for ultrasound of the abdominal aorta, 76706, Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA). The code is specific to screening for AAA. For ultrasound or duplex ultrasound of the abdominal aorta other than screening, CPT instructs you to see 76770, 76775, 93978, and 93979.

Added Instructions Help Guide Your Coding
In several instances, CPT 2017 adds language to help you choose the correct code. Examples include the following:

• Epidurography 72275, Epidurography, radiological S&I, is unchanged, but a new parenthetical instruction specifies, "for injection procedure, see 62280, 62281, 62282, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64479, 64483, 64484."

• The code for transrectal ultrasound (76872) is unchanged, but new instructions confirm that you may not report this service with sigmoidoscopy procedures 45341, 45342, 45391, or 45392, hemorrhoid ligation 0249T, or transuretheral waterjet ablation of prostate 0421T.

• An added instruction under 76937 Epidurography, radiological S&I directs, "If extremity venous noninvasive vascular diagnostic study is performed separate from venous access guidance, see 93970, 93971."

Sedation No Longer Included in Radiation Treatment Delivery, Hyperthermia
Lastly, CPT no longer defines conscious sedation as an inherent part of any procedure. Those codes that previously were valued to include conscious sedation (when performed) have been revalued so that they no longer include conscious sedation. Although the value of those codes has fallen, conscious sedation, when performed and properly documented, may be reported separately. Per the 2017 Physician Fee Schedule Proposed Rule, "This coding change [provides] for payment for moderate sedation services only in cases where it is furnished." The change affects the following five codes found in the Radiology section: Radiation treatment delivery 77371 and hyperthermia services 77600, 77605, 77610, and 77615.

— G. John Verhovshek, MA, CPC, is managing editor for AAPC, the nation's largest medical credentialing organization.