HAP Radiology Billing and Coding Blog

Coding Changes That Will Impact Radiology Practices In 2020

Posted: By Erin Stephens on January 09, 2020

Coding Changes That Will Impact Radiology Practices In 2020With the new year comes the annual revision of Current Procedural Terminology[i] (CPT)® coding that practices have to be aware of.  For diagnostic radiology, the changes for 2020 are relatively few and they are concentrated in the areas of abdominal and gastrointestinal plain films, nuclear medicine procedures for tumor localization, and myocardial PET imaging.  The changes to interventional radiology coding are likewise quite limited and involve pericardial and spinal puncture procedures. 


Watch a recording of our webinar 2020 Updates to the MPFS & Radiology  Reimbursement Impact

Diagnostic Radiology

Abdominal and Gastrointestinal Imaging

These exams now include all scout films and delayed images in the basic procedure code, and distinction is made between single and double contrast studies. 

  • Complete Acute Abdomen Series (74022) - The code now specifies that two or more views of the abdomen must be included, for example supine, erect, and/or decubitus.

  • Pharynx and/or Cervical Esophagus (74210) - The code now specifies that this is a barium contrast exam that includes scout neck radiograph(s) and delayed image(s).

  • Esophagus - The codes now include scout chest radiograph(s) and delayed image(s).
    • Use 74220 (revised) for a single contrast exam.
    • Use 74221 (new) for a double contrast exam (e.g., high density barium and an effervescent agent).

  • Swallowing Function (74230) - The code now specifies that this is a barium contrast exam that includes scout neck radiograph(s) and delayed image(s).

  • Upper Gastrointestinal Tract - The codes now include scout abdominal radiographs and delayed images.
    • Use 74240 (revised) for a single contrast exam.
    • Use 74246 (revised) for a double contrast exam (e.g., high density barium and an effervescent agent) including glucagon when administered.
    • Add 74248 (new) to either of these codes to report small intestine follow-through studies.
    • The following have been deleted:
      • 74241, replaced by 74240
      • 74245, replaced by 74240 + 74248
      • 74247, replaced by 74246
      • 74249, replaced by 74246 + 74248

    • Small Intestine - The codes now include multiple serial images and scout abdominal radiograph(s) and delayed image(s). Existing codes have been revised:
      • Use 74250 for single contrast exam.
      • Use 74251 for a double contrast exam (e.g., high density barium and air via enteroclysis tube).
      • For Duodenogram, 74260 has been deleted and replaced by 74251.

    • Colon - The codes now include scout abdominal radiographs and delayed images. Existing codes have been revised:
      • Use 74270 for a single contrast exam.
      • Use 74280 for a double contrast exam (e.g., high density barium and air) including glucagon when administered.

Nuclear Medicine

New codes were added to report tumor localization using SPECT and SPECT/CT. 

CPT Code Description

78830

New

SPECT with concurrent CT for anatomical review, localization and determination/detection of pathology;

          Single area (e.g., head, neck, chest, pelvis)
          Single day imaging

78831

New

SPECT only for anatomical review, localization and determination/detection of pathology;

           Minimum 2 areas (e.g., pelvis and knees, abdomen and pelvis)

           Single day imaging, or

           Single area imaging over 2 or more days

78832

New

SPECT with concurrent CT for anatomical review, localization and determination/detection of pathology;

          Minimum 2 areas (e.g., pelvis and knees, abdomen and pelvis)

          Single day imaging, or

          Single area imaging over 2 or more days

78835

New

Add-on

Radiopharmaceutical quantification measurement(s)

         Single area

         Use with 78830 or 78832

         Report multiple units for more than 1 area or more than one day of imaging

 

These scans were previously reported using 78805, 78806 and 78807.

 

The following codes have all been deleted and will now be reported using the tumor localization code 78803 (SPECT, single area, single day imaging):

  • 78205 and 78206 Liver Imaging (SPECT)
  • 78320 Bone and Joint Imaging (SPECT)
  • 78607 Brain Imaging (SPECT)
  • 78647 Cerebrospinal Fluid Flow Imaging (cisternography) (SPECT)
  • 78710 Kidney Imaging (SPECT)

The reporting of Myocardial PET imaging has been enhanced with the addition of 6 new codes.  Here is a complete rundown of the relevant code sequences:

 

New and Revised Myocardial PET Coding

CPT Code Description

78459

Revised

Metabolic evaluation study (including ventricular wall motion and/or ejection fractions, when performed)

          Single study

78429

New
          With concurrent CT imaging

78491

Revised

Perfusion study (including ventricular wall motion and/or ejection fractions, when performed)

          Single study, at rest or stress (either exercise or pharmacologic)

78430

New

          Single study, at rest or stress (either exercise or pharmacologic)

          With concurrent CT imaging

78492

Revised
          Multiple studies at rest and stress (either exercise or pharmacologic)

78431

New

          Multiple studies at rest and stress (either exercise or pharmacologic)

          With concurrent CT imaging

78432

New

Combined perfusion with metabolic evaluation study (including ventricular wall motion and/or ejection fractions, when performed)

          Dual radiotracer (e.g., myocardial viability)

78433

New
         With concurrent CT imaging

78434

New

Add-on

Absolute quantitation of myocardial blood flow (AQMBF)

           Rest and pharmacologic stress

           Use with 78431 or 78492

Other Diagnostic Radiology

There are two new codes for Arterial Inflow and Venous Outflow for Pre-operative Vessel Assessment prior to the creation of hemodialysis access using duplex Doppler ultrasound.  These codes replace the HCPCS[i] code G0365.

  • 93985 Complete bilateral study
  • 93986 Complete unilateral study

Category III HCPCS codes in the range of 0554T – 0557T have been created for Bone Strength and Fracture Risk Assessment using CT, however these are not yet covered services for Medicare reimbursement.

Interventional Radiology 

The reporting of pericardiocentesis and pericardial drainage has been enhanced by the addition of 4 new codes that expand upon 3 deleted codes.  The new codes include all imaging guidance, when performed.

 

CPT Code Description

33016

New

Pericardiocentesis, including imaging guidance

          Replaces 33010 and 33011

33017

New

Pericardial drainage with insertion of indwelling catheter, percutaneous,

          Including fluoroscopy and/or ultrasound guidance

          Age 6 and older without congenital cardiac anomaly

33018

New

          Including fluoroscopy and/or ultrasound guidance

          Up to 5 years of age or any age with congenital cardiac anomaly

33019

New
         Including CT guidance

 

Tube Pericardiostomy is now reported using 33017, 33018 or 33019 rather than the deleted code 33015.

 

Lumbar puncture procedure reporting has been expanded by the addition of two new codes that incorporate fluoroscopic or CT imaging guidance.

 

CPT Code Description

62270

Revised
Spinal puncture, lumbar, diagnostic

62328

New
          With fluoroscopic or CT guidance

62272

Revised
Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter)

62329

New
          With fluoroscopic or CT guidance

 

If MRI guidance is used, then 77021 may be added to 62270 and 62272.  If ultrasound guidance is used, then 76942 may be added. 

Contact HAP

Conclusion

As compared with other years, coding changes for 2020 are relatively few.  Although Medicare has reported that the overall effect of revisions to the 2020 Medicare Physician Fee Schedule on radiology practices will be minimal, we will separately analyze the financial impact of these and other valuation changes in an upcoming article.  Each practice has to evaluate any fee schedule changes in light of its mix of modalities and procedure volume.  Be sure to subscribe to this blog as we give you the information you need to understand and analyze the ongoing changes in radiology reimbursement.

 

[i] Current Procedural Terminology is a copyrighted code set developed and maintained by the American Medical Association, and CPT is a registered trademark.

[i] HCPCS (Healthcare Common Procedure Coding System) Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, America's Health Insurance Plans,  and the Blue Cross and Blue Shield Association).

 

Erin Stephens, CPC, CIRCC  is the Sr. Client Manager, Education at Healthcare Administrative Partners. 

 

Related Articles

 

Get Ready for Changes to Radiology Billing in 2020

 

Update on Surprise Billing Legislation Across the Country

 

How the Medicare Final Rule For 2020 Will Affect Radiologists

 

Inside advice from radiology RCM experts

 

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Topics: radiology coding, IR coding, CPT codes

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