You have a whole host of Current Procedural Terminology (CPT®) coding changes to deal with for 2019 – and you can’t afford to overlook a single new, revised, or deleted code. From significant revisions to coding fine needle aspiration (FNA), to new ultrasound elastography codes, here are just a few of the CPT® updates for diagnostic radiology coders.
The American Medical Association (AMA) just released the new CPT® codes for 2019, which take effect on January 1. You need to make sure you’re current on the 2019 radiology CPT® guidelines and prepared to meet diagnostic test order requirements and medical necessity for radiology—so you don’t lose out on deserved reimbursement, says coding guru Stacie L. Buck in her 2019 Coding Updates Virtual Boot Camp sessions on Radiology.
8 New FNA Codes Replace 10022
What’s new: The American College of Radiology (ACR) correctly predicted major revisions to CPT® codes for FNA, anticipating several new codes that bundle the procedure and the radiological supervision and interpretation. CPT® deleted 10022 — Fine needle aspiration; with imaging guidance, and replaced it with the following:
- 10005 — Fine needle aspiration biopsy, including ultrasound guidance; first lesion
- 10006 — …including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure)
- 10007 — …including fluoroscopic guidance; first lesion
- 10008 — …including fluoroscopic guidance; each additional lesion (List separately in addition to code for primary procedure)
- 10009 — …including CT guidance; first lesion
- 10010 — …including CT guidance; each additional lesion (List separately in addition to code for primary procedure)
- 10011 — …including MR guidance; first lesion
- 10012 — …including MR guidance; each additional lesion (List separately in addition to code for primary procedure)
Reason: The AMA’s Relativity Assessment Workgroup (RAW) identified the FNA code 10022 as being reported together with 76942 more than 75 percent of the time, which lead to referral to the CPT® Editorial Panel for a bundling, ACR noted.
The new FNA codes include instructional notes with the FNA and core needle biopsy definitions, according to Deborah Grider, CPC, Certified Clinical Documentation Improvement Practitioner, in a recent blog posting for ICD10monitor. Because CPT® added imaging guidance to the new codes, you can no longer report it separately.
Tip: You should select the codes based on the imaging guidance used and add-on codes for each additional lesion with the same imaging modality, Grider stated. If more than one lesion is involved, but different imaging modalities are used, you should append modifier 59.
Breast MRI Codes Get a Makeover
More: CPT® will delete three breast magnetic resonance imaging (MRI) codes:
- 77058 — Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral
- 77059 — …bilateral
- 0159T — Computer-aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI (List separately in addition to code for primary procedure)
Instead, you’ll have four new breast MRI codes: two for breast MRI (with and without contrast) and two that bundle computer-aided detection (CAD), according to the Radiology Coding Certification Board. The four new codes are:
- 77046 — Magnetic resonance imaging, breast, without contrast material; unilateral
- 77047 — …without contrast material; bilateral
- 77048 — …without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral
- 77049 — …without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral
Tip: You should select the correct breast MRI code based on laterality (unilateral versus bilateral) and with or without contrast material, Grider advised.
Ultrasound Elastography to Finally Get RVUs
Another important coding addition is the new CPT® codes for contrast enhanced ultrasound (CEUS) and elastography. Ultrasound elastography is currently a Category III code with no assigned Relative Value Unit (RVU) for payment, but this type of study is continuing to grow among radiology practices, according to ADVOCATE Radiology Billing and Reimbursement Specialists.
The following newly added CPT® codes for both ultrasound and MR elastography are:
- 76391 — Magnetic resonance (eg, vibration) elastography
- 76981 — Ultrasound, elastography; parenchyma (eg, organ)
- 76982 — …first target lesion
- 76983 — …each additional target lesion (List separately in addition to code for primary procedure)
Key takeaway: Make sure you have a solid understanding of the 2019 CPT® code changes, including the revised radiology CPT® guidelines, Buck stresses. Also, ensure that you understand the requirements for medical necessity for radiology—specifically for diagnostic radiology reports—so you can correctly code services and capture appropriate payments.
