Health Information Management

2010 CPT changes: Rethink revamped radiology codes

JustCoding News: Outpatient, January 27, 2010

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Three changes in diagnostic and interventional radiology will require coders to rethink how they code and bill cardiac computed tomography (CT), myocardial perfusion studies, and arteriovenous (AV) dialysis fistula access.

“It really is a matter of forgetting everything we knew about coding for these procedures, starting from scratch, and getting out of the habit of having one primary code,” says Stacy Gregory, CPC, CCC, RCC, radiology coding consultant for Health Record Services in Baltimore.

Heart CT

The codes for cardiac CT angiography (CTA) moved from Category III codes to Category I codes. In addition, the AMA reduced the number of codes from seven to four. The new codes are:

  • 75571: CT, heart, without contrast material, with quantitative evaluation of coronary calcium  
  • 75572: CT, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3-D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)  
  • 75573: CT, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3-D image postprocessing, assessment of LV cardiac function, RV structure, and function and evaluation of venous structures, if performed)  
  • 75574: CTA, heart, coronary arteries, and bypass grafts (when present), with contrast material, including 3-D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)

Code 75571 replaces 0144T. Use 75572 in place of 0145T. Code 75573 replaces 0150T, and code 75574 replaces 0146T–0149T.

Due to the frequency of these studies, they’ve now undergone sufficient clinical trials and merit permanent Category I CPT codes rather than an “evaluation of new technology” temporary Category III code, explains Gregory.

“It completely changes the way we’ve been looking at those procedure codes, what is included in each of them, and what is being represented by these new codes,” Gregory says.

She also sees the transition from seven codes to four as a challenge and notes the move from alphanumeric to solely numeric codes located in the radiology section.

Myocardial perfusion studies

Coders will confront a slightly different problem with myocardial perfusion studies. The new codes now include wall motion and ejection fraction, which coders previously reported separately using add-on codes. The following new codes replace codes 78460, 78461, 78464, 78465, 78478, and 78480:

  • 78451: Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) 
  • 78452: Multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection 
  • 78453: Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) 
  • 78454: Multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

“Instead of having three codes, we are going to have one code that represents the entire procedure,” Gregory says.

Now, when wall motion evaluation or ejection fraction are performed during a myocardial perfusion study, they are considered inclusive to the base study and you should not report them separately. When wall motion and/or ejection fraction are not performed, it is still appropriate to select from the new codes without adding a limiting modifier.

“The way these codes are being changed to represent the entire procedure rather than different portions is like starting from scratch,” Gregory says.

AV dialysis fistulas

The same type of change has occurred with AV dialysis fistula access codes. The AMA deleted the previous codes for AV dialysis fistula access and created an all-inclusive code that encompasses the imaging as well as the catheter placement.

The AMA deleted codes 36145 (Introduction of needle or intracatheter; AV shunt created for dialysis [cannula, fistula, or graft]) and 75790 (Angiography, AV shunt [e.g., dialysis patient], radiological supervision and interpretation).
Instead, use the following codes:

  • 36147: Introduction of needle and/or catheter, AV shunt created for dialysis (graft/fistula); initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection[s] of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava) 
  • + 36148: Additional accesses for therapeutic intervention (list separately in addition to code for primary procedure) 
  • 75791: Angiography, AV shunt (e.g., dialysis patient fistula/graft), complete evaluation of dialysis access, including fluoroscopy, image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through the entire venous outflow including the inferior or superior vena cava), radiological supervision and interpretation

Code 75791 represents imaging performed without direct access. This could either be via selective catheter placement or through an existing access. Use code 75791 instead of code 36147; never report codes 75791 and 36147 together.

Also, because code 36148 represents an access of the fistula in addition to the primary access, you should never report it alone; it will always accompany code 36147.

“The whole dynamic has changed for this particular procedure,” Gregory says. “The instructions for coding them are completely different, so we have to relearn how we’ve coded these since component coding was introduced.”

Editor’s note: This article was originally published in the February issue of Briefings on APCs. E-mail your questions to Managing Editor Michelle Leppert at mleppert@hcpro.com.



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