HAP Radiology Billing and Coding Blog

Coding Changes That Will Impact Radiology Practices In 2021

Posted: By Erin Stephens on January 6, 2021

Coding Changes That Will Impact Radiology Practices In 2021The big news in Current Procedural Terminology[i] (CPT)® revisions for 2021 is the overhaul of the Evaluation and Management (E&M) section, reducing documentation requirements, and introducing new rules for determining the level of coding. These changes will affect interventional radiologists and radiation oncologists more than they will the day-to-day work of diagnostic radiologists. First, we will review the other non-E&M code changes affecting diagnostic and interventional radiology for 2021.


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Diagnostic Radiology 

Chest CT and Lung Cancer Screening

The code for low-dose lung cancer screening (G0297) has been replaced by new code 71271.  The code G0296, “Counseling visit to discuss need for lung cancer screening”, remains in use for 2021.   The professional component of the new code 71271 has been assigned a 4.8% higher RVU value than G0297 had, while the global RVU has been slashed 36%; however, due to the revaluation of the conversion factor the pricing for the PC increased only slightly while the global value decreased 38% as shown here:

 

 

2021 (71271)

2020 (G0297)

 

 

RVU value

Fee Schedule*

RVU value

Fee Schedule

Professional component

Work RVU

1.08

 

1.02

 

Total RVU

(+4.8%) 1.52

(+1.4%) $53.04

1.45

$52.33

Global

Work RVU

1.08

 

1.02

 

Total RVU

(-36%) 4.32

(-38%) $150.74

6.70

$241.80

                   * Using the values finalized by the Consolidated Appropriations Act.

The codes that describe CT Thorax (71250-71270) are now to be used only for diagnostic exams, not screening exams.

Breast CT

New codes have been created for breast CT exams, as follows:

CT Breast, including 3D rendering when performed:

Unilateral

Bilateral

Without contrast

0633T

0636T

With contrast

0634T

0637T

Without contrast followed by with contrast

0635T

0638T

Miscellaneous

  • CPT code 74425 “Urography, antegrade, radiological supervision and interpretation” may now be used with any antegrade exam. Previously it was specifically for a pyelostogram, nephrostogram, or loopogram only.
  • CPT code 76970, “Ultrasound study follow-up,” has been deleted.
  • CPT code 78135, “Red cell survival study; differential organ/tissue kinetics (e.g., splenic and/or hepatic sequestration),” has been deleted.

Interventional Radiology 

Lung Biopsy

The code 32405, “Biopsy, lung or mediastinum, percutaneous needle,” has been replaced by new code 32408, “Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed.” Accordingly, imaging guidance may no longer be billed separately. When more than one core needle biopsy of the lung or mediastinum is performed on separate lesions during the same session on the same day, then 32408 is billed once for each additional lesion along with modifier -59.

Cardiac Catheterization

A new series of codes was created to report the creation of effective intracardiac blood flow in the setting of congenital heart defects. Our coders recommend that the CPT book should be consulted to be sure the extensive guidelines related to these procedures are followed. The new codes are described as follows:

 

CPT Code

Description

33741

Transcatheter atrial septostomy (TAS) for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, any method (e.g., Rashkind, Sang-Park, balloon, cutting balloon, blade)

33745

Transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including:

  • All imaging guidance by the proceduralist, when performed
  • Left and right heart diagnostic cardiac catheterization for congenital cardiac anomalies, and
  • Target zone angioplasty, when performed (e.g., atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles)

Initial cardiac shunt

33746

Add-on

Each additional intracardiac shunt location

 

Note that multiple stents placed in a single location may only be reported with a single code (33745). Add-on code 33746 is to be used when additional stents in different intracardiac locations are placed in the same session.

Ventricular Assist Device (VAD) Insertion

The coding of these procedures was revised to differentiate between left- and right-heart procedures, encompassing either initial placement or replacement of a percutaneous VAD.

CPT Code

Description

 

Insertion of ventricular assist device (VAD), percutaneous including radiological supervision and interpretation;

33995

Right heart, venous access only

33990

Left heart, arterial access only

33991

Left heart, both arterial and venous access, with transseptal puncture

 

Removal of percutaneous ventricular assist device (VAD), at separate and distinct session from insertion;

33992

Left heart, arterial or arterial and venous cannula(s)

33997

Right heart, venous cannula

33993

Repositioning of percutaneous right or left heart ventricular assist device (VAD) with imaging guidance at separate and distinct session from insertion.

Endovascular Venous Arterialization

Coding has been available for endovascular revascularization (37228-37231 and 0505T), but not for arterialization. A new code (0620T) has been created as follows:

“Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including

  • percutaneous or open vascular access,
  • ultrasound guidance for vascular access when performed,
  • all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, and
  • all associated radiological supervision and interpretation, when performed.”

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Ultrasound Ablation of Pulmonary Arteries

A new code (0632T) has been created as follows:

“Percutaneous transcatheter ultrasound ablation of nerves innervating the pulmonary arteries, including

  • right heart catheterization
  • pulmonary artery angiography, and
  • all imaging guidance.”

Evaluation and Management (E&M) Services

Under the revised E&M coding structure, physicians may elect to document a visit based either on time spent or medical decision-making. Level 1 (99201) for new patients has been eliminated, leaving four levels of billing for new patients and five levels for established patients.

Until now the level of coding has been determined by evaluating the three components of an exam, plus the time spent face-to-face with the patient.

  1. the patient’s history,
  2. the physical examination, and
  3. the level of medical decision-making,

The new system that begins in 2021 will be based only on

  • the level of medical decision-making or
  • the total time involved in the service of the patient, including non-face-to-face activities performed by the physician.

The following table summarizes the criteria for a new patient:

 

For a new patient with medically appropriate history and/or physical exam and

CPT Code

Medical Decision-Making is

Time Spent is

99202

Straightforward

15-29 minutes

99203

Low

30-44 minutes

99204

Moderate

45-59 minutes

99205

High

60-74 minutes

 

For an established patient, a Level 1 visit (CPT 99211) might not require a physician to be involved. This could be a nurse visit or blood pressure check. There is minimal medical decision-making and no prescribed time element. The remaining billing levels for an established patient are summarized as follows:

 

 

For an established patient with medically appropriate history and/or physical exam and

CPT Code

Medical Decision-Making is

Time Spent is

99212

Straightforward

10-19 minutes

99213

Low

20-29 minutes

99214

Moderate

30-39 minutes

99215

High

40-54 minutes

 

Medicare has approved a new code, G2212, to be used for encounters that exceed the maximum time for a Level 5 (99205/99215) visit. Its description is “Prolonged office or other outpatient evaluation and management services (beyond the total time of the primary procedure which has been selected using total time), requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service; each 15 minutes.” This mirrors the language of CPT code 99417 that might be approved by payers other than Medicare.

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Conclusion

The coding changes described here will have minimal impact on the daily work of diagnostic radiologists, while interventionalists and radiation oncologists will have to become familiar with the revised E&M coding and documentation structure. Other than the global fee cut to the CT Lung Screening code, these changes will have little financial impact directly. However, the restructuring of the E&M section has far-reaching reimbursement implications across the spectrum of the Medicare Physician Fee Schedule.

 

Our webinar, 2021 Updates to the Medicare Physician Fee Schedule & Radiology Reimbursement Impact, has additional information about these coding changes and other news of interest to radiology practices. Of course, also subscribe to this blog for the latest developments.

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


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

 

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Topics: radiology coding, interventional radiology, IR coding, CPT codes, radiology, diagnostic radiology

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