December 2017

Coding Corner: Numerous Changes to Radiology Codes on Tap: CPT 2018 Revisions Summary
By John Verhovshek, MA, CPC
For The Record
Vol. 29 No. 12 P. 28

Of the approximately 300 code changes—category I and category III additions, revisions, and deletions—in the 2018 CPT manual, the following changes are specific to radiology services.

Chest and Abdominal Exams
Codes for chest X-rays are simplified: Nine codes are deleted and replaced by four new codes, which are based solely on the number of views.

Deleted
• 71010 Radiologic examination, chest; single view, frontal;
• 71015 … stereo, frontal;
• 71020 Radiologic examination, chest, 2 views, frontal and lateral;
• 71021 … with apical lordotic procedure;
• 71022 … with oblique projections;
• 71023 … with fluoroscopy;
• 71030 Radiologic examination, chest, complete, minimum of 4 views;
• 71034 … with fluoroscopy; and
• 71035 Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies).

Added
• 71045 Radiologic examination, chest; single view;
• 71046 … 2 views;
• 71047 … 3 views; and
• 71048 … 4 or more views.

The deleted codes (71010–71035) were potentially misvalued. The American College of Radiology requested an update to increase the flexibility and accuracy when coding customized exams.

Codes describing radiologic examination of the stomach are similarly revised, for similar reasons, to be reported based on the number of views.

Deleted
• 74000 Radiologic examination, abdomen; single anteroposterior view;
• 74010 … anteroposterior and additional oblique and cone views; and
• 74020 … complete, including decubitus and/or erect views.

Added
• 74018 Radiologic examination, abdomen; 1 view;
• 74019 … 2 views; and
• 74021 … 3 or more views.

Angiography
Angiography code 75658 Angiography, brachial, retrograde, radiological supervision and interpretation, is deleted for 2018. Going forward, the service is to be reported using an existing upper extremity angiography code (eg, 73225 Magnetic resonance angiography, upper extremity, with or without contrast material[s]).

Angiography code 36120 Introduction of needle or intracatheter, retrograde brachial artery, is also deleted. As a replacement, code 36410 becomes a standalone code and is revised to indicate: Introduction of needle or intracatheter, upper or lower extremity artery.

Endovascular Repairs
On the recommendations of the American Medical Association's Relativity Assessment Workgroup, three 70000-series codes related to endovascular repairs are deleted in 2018, to be replaced by new codes that bundle radiological services.

Deleted
• 75952 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation;

• 75953 Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal aortic or iliac artery aneurysm, pseudoaneurysm, or dissection, radiological supervision and interpretation; and

• 75954 Endovascular repair of iliac artery aneurysm, pseudoaneurysm, arteriovenous malformation, or trauma, using ilio-iliac tube endoprosthesis, radiological supervision and interpretation.

Added
• 34701 Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including preprocedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the aortic bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the aortic bifurcation; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer);

• 34702 … for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption);

• 34703 Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including preprocedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the iliac bifurcation; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer);

• 34704 … for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption);

• 34705 Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including preprocedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the iliac bifurcation; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer); and

• 34706 … for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption).

Additional codes 34707–34713 are introduced to report services related to such repairs.

To accommodate the above endovascular repair changes, category III code 0255T Endovascular repair of iliac artery bifurcation (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using bifurcated endoprosthesis from the common iliac artery into both the external and internal iliac artery, unilateral; radiological supervision and interpretation, is deleted; and 0254T Endovascular repair of iliac artery bifurcation (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma, dissection) using bifurcated endograft from the common iliac artery into both the external and internal iliac artery, including all selective and/or nonselective catheterization(s) required for device placement and all associated radiological supervision and interpretation, unilateral, is revised to include radiological supervision and interpretation.

Fluoroscopy and Ultrasound Revisions
One fluoroscopy and two ultrasound codes are revised to better specify the nature of the services:

• 76000 Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 (eg, cardiac fluoroscopy), is revised to 76000 Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time.

• 76881 Ultrasound, extremity, nonvascular, real-time with image documentation; complete, is revised to 76881 Ultrasound, complete joint (ie, joint space and peri-articular soft tissue structures), real-time with image documentation.

• 76882 … limited, anatomic specific, is revised to 76882 Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft tissue structure[s], or soft tissue mass[es]), real-time with image documentation.

For the ultrasound codes, report a "complete" service when examining the joint space and the surrounding soft tissues and a "limited" service if the exam involves a joint space or surrounding soft tissues.

Neutron Radiation and Kinetics
The following two 70000-series codes are deleted due to low utilization:

• 77422 High energy neutron radiation treatment delivery; single treatment area using a single port or parallel-opposed ports with no blocks or simple blocking; and

• 78190 Kinetics, study of platelet survival, with or without differential organ/tissue localization.

Category III Conversions
Two services previously described using category III codes that include imaging guidance have been converted to category I code status.

Code 0340T Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance, is deleted. The service now is to be reported using 32994 Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; cryoablation.

Code 0438T Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance, is deleted and replaced by 55874 Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed.

— John Verhovshek, MA, CPC, is managing editor of AAPC.