As you well know, diagnostic radiology requires precision when it comes to coding – so much so that you probably wish you had x-ray vision to quickly assess the situation and pick the right code. Because of the high volume of their work, diagnostic radiologists don’t always give the most detailed medical reports, meaning you have to be extra careful when translating the documentation into billable codes.
This year’s changes to Current Procedural Terminology (CPT®) and ICD-10-CM codes include changes to needle aspiration, bone density ultrasound, and breast magnetic resonance imaging (MRI) with computer-aided detection (CAD), among others, says coding consultant Stacie Buck in her presentation on 2019 CPT® and ICD-10-CM updates for diagnostic radiology. Here are some of the key changes coming for radiology coders…
CPT® Codes: Avoid Bundling Errors
The changes to CPT® codes this year, as usual, relate to bundling. Remember that you can bundle codes together if the services are performed together at least 75 percent of the time, says the American College of Radiology (ACR). CMS has not yet released the code updates, but here’s an idea of the changes you can expect to take on Jan. 1, 2019:
Fine Needle Aspiration
- Look for a change to code 10021.
- Code 10022 is set for deletion, since CMS found it was reported with code 76945 — Under ultrasonic guidance procedures more than 75 percent of the time.
- Big news: Look for nine new codes that bundle radiological supervision and interpretation (RS&I) with the procedure, says the Radiology Coding Certification Board (RCCB)
Breast MRI with CAD
With this year’s additions, breast MRI codes will move from Category III (codes that describe emerging technology without an assigned relative value unit (RVU) for payment) to Category I.
- Say goodbye: Codes 77058, 77059, and 0159T will be deleted.
- Look out for four new breast MRI codes. Two will report breast MRIs with and without contrast, and two others will bundle CAD with the procedure.
Ultrasound Elastography (UE)
The purpose of this year’s new UE codes is to specify which organ as well as denote initial or subsequent target lesions.
- Look out for three new UE codes.
- Forget about code 0346T — Under subcutaneous implantable defibrillator system. As of Jan. 1, 2019, this code will be deleted.
Knee Arthography
- No more code 27370 — Under introduction or removal procedures on the femur (thigh region) and knee joint. As ACR reports, coders too often confused this procedure with arthrocentesis or aspiration. If deleted, CMS will replace 27370 with a new code that reports an injection procedure for knee arthography or a computed topography (CT)/MRI knee arthrography.
Magnetic Resonance Elastography (MRE)
- MRE is a new technology, which is why there wasn’t previously any CPT code for it – but the exciting news is now there will be!
Contrast Enhanced-Ultrasound (CEUS)
- Be on the lookout for two new codes for reporting ultrasound procedures involving dynamic microbubble-sonographic contrast with targeted ultrasound to evaluate lesions.
Bone Density Ultrasound
- Starting Jan. 1, you’ll have to use a new Category III code to report pulse-echo ultrasound bone density measurements for bone mineral density analysis.
Positron Emission Tomography (PET) Absolute Quantitation Myocardial Blood Flow
- Yet another Category III code for you to learn – this one will report PET absolute quantitation of myocardial blood flow both at rest and
Specific Codes Veer Away from ‘Unspecified’
In contrast to all the proposed CPT® code changes this year, those for ICD-10-CM are relatively simple. For the six added codes taking effect Oct. 1, 2018, you have to know which testical or “other specified body structure” was examined, although R93.819 does still give you an out if the documentation isn’t clear:
Abnormal radiologic findings on…
- 81* (parent code, nonbillable), diagnostic imaging of testis
- 811, diagnostic imaging of right testicle
- 812, diagnostic imaging of left testicle
- 813, diagnostic imaging of testicles, bilateral
- 819, diagnostic imaging of unspecified testical
- 89, diagnostic imaging of other specified body structures
Two code sets, two different effective dates: The ICD-10-CM changes take effect Oct. 1, 2018, but the CPT® changes don’t take effect until Jan. 1, 2019.
Your Vital Role in Patient Health
Remember: More than ever, you’re being given the tools to paint as full a picture as possible of patients’ health, says Buck. More tools can mean more confusion, but it doesn’t have to – get a head start now on the upcoming changes to bill with confidence in 2019.
Good day, My name is Gloria Motola. Im a Radiographer with many years of experience , but not in USA. I have not my Board yet, but while I get that I would like to work in a front desk . I applied already in a Radiologist Imaging Center and they didn’t accept me because I don’t know about the Radiologic CPT and ICD 10 codes. My question is How can I get knowledges about this topic and how diificult is to learn that if I know the terminologist in Radiologic. Thanks in advance. Regards Mrs Gloria Motola.