Effective January 1, 2015, there will be 320 CPT code changes, which include 175 new, 47 deleted and 107 revised codes. Of that total, there are 28 new codes for radiology.  To help you stay informed, our team has prepared this overview of some of the most significant changes and revisions you can expect.

 

You will notice that bundling continues to increase in special procedures and interventional radiology and there are significant changes in breast imaging and radiation therapy.  The new codes and guidelines are effective January 1st. Your documentation should be tailored to these changes by that date.

 

If you have any questions about these changes, please your MSN representative for more information.

 

 

Breast Imaging

 Three new codes for breast tomosynthesis.

 

Existing code for breast Ultrasound 76645 was deleted and two new codes introduced for limited and complete ultrasound.

•       76641 (New)Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete
•       76642 (New) Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited
•       77061 (New) Digital breast tomosynthesis; unilateral
•       77062 (New) Digital breast tomosynthesis; bilateral
•       77063 (New) Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)

 

Vertebral Fracture Assessment

 

The existing code 77082 has been deleted and two new codes have been introduced - one for VFA done as part of a bone density study and the other for VFA alone.

•     77085 (New) Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (e.g, hips, pelvis, spine), including vertebral fracture assessment
•     77086 (New) Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA)

 

Special Procedures - Joint Procedures

 

Three new codes for joint aspiration and/or injection have been created to include ultrasound guidance. The existing codes 20600, 20605, 20610 were revised to state "not using ultrasound guidance." There are times when fluoroscopic guidance 77002 is performed, which was not addressed with new codes.

•       20604 (New) Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting
•       20606 (New) Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting
•       20611 (New) Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting

 

Special Procedures - Ablation Therapy

 

The existing code for radiofrequency bone ablation has been updated to include adjacent soft tissue and radiologic guidance. In addition, a new code has been added for cryoablation of bone tumors. A category III code has also been created for cryoablation of pulmonary tumors.

•      20982 (Revised) Ablation therapy for reduction or eradication of 1 or more bone tumors(e.g, metastasis)  including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency
•       20983 (New) Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; cryoablation
•       47383 (New) Ablation, 1 or more liver tumor(s), percutaneous cryoablation
•       0340T (New) Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance

 

Special Procedures - Myelography

 

Four new myelography codes were created which bundle lumbar injections as well as the radiology supervision and interpretation (RSI). These are only applicable to a lumbar spine injection procedure and only when both components are performed by the same physician. If two different physicians perform the injection procedure and the RSI, the combination codes are not used. The RSI codes 72255, 72265 or 72270 are then coded separate from the injection code. In addition, if the myelogram is performed by a C1-C2 injection 61055 instead of a lumbar spine injection, the new combination codes are not used.

•       61055 (Revised) Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment
•       62284 (Revised) Injection procedure for myelography and/or computed tomography, spinal lumbar (other than C1-C2 and posterior fossa)
•       62302 (New) Myelography via lumbar injection, including radiological supervision and interpretation; cervical
•       62303 (New) Myelography via lumbar injection, including radiological supervision and interpretation; thoracic
•       62304 (New) Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral
•       62305 (New) Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)

 

Special Procedures - Vertebroplasty/Kyphoplasty

 

The existing codes for vertebroplasty and kyphoplasty have been deleted 22520-22525, 72291-72292 and six new codes have been created that bundle all imaging guidance. Sacroplasty remains a Category III code and has been revised to include all imaging guidance.

•       22510 (New) Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic
•       22511 (New) Lumbosacral
•       +22512 (New) Each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)
•       22513 (New) Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic
•       22514 (New) Lumbar
•       +22515 (New) Each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)

 

Vertebroplasty/Kyphoplasty Category III Codes

 

The following Category III Tracking Codes have been extended another 5 years.

•       0200T (Revised) Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed
•       0201T (Revised) Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed

 

Special Procedures - Interventional Radiology

• 34839 (New) Physician planning of a patient-specific fenestrated visceral aortic endograft requiring a minimum of 90 minutes of physician time

 

Interventional Radiology

 

Existing codes for carotid stent placement have been revised to include angioplasty and radiologic supervision and interpretation.  Verbiage has been added stating that it can be used for open or percutaneous approach.

•       37215  (Revised) Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection
•       37216 (Revised) Without distal embolic protection
•       37218  (New) Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation. Previously a Category III code, there is now a CPT code for placement of intrathoracic common carotid or innominate artery stent. 

 

Interventional Radiology - Category III Revised

 

These are now limited to extracranial vertebral artery. The intrathoracic carotid artery now has its own CPT (above.)

•       0075T (Revised) Transcatheter placement of extracranial vertebral or intrathoracic carotid artery stent(s), including radiologic supervision and interpretation, percutaneous; initial vessel
•       0076T (Revised) Each additional vessel
•       0126T (Deleted) Common carotid intima-media thickness (IMT) study, is marked for deletion and was replaced by the new code below
•       93895 (New) Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral, replaces code above.

 

Interventional Radiology - Cervicocerebral Angiography

 

The introductory section has been revised to add instructions that CPT code (36228) includes all intracranial branches of the unilateral internal carotid or unilateral vertebral artery. It may be reported one time for all branches of one primary branch of the internal carotid artery (the anterior cerebral or middle cerebral) and one time for each branch of the vertebral or basilar artery. It may not be reported more than twice per side. CPT code 36228 can now be added on to codes 36223 and 36225 in addition to last year's guidelines of 36224 and 36226.

•       36228 (Revised) Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (List separately in addition to code for primary procedure).

 

Codes (36218) and (75774) may not be used for cerebral angiography. They may be used to report upper extremity angiography branch selections and imaging performed in the same setting as selective or non-selective vertebral arteriography. They are used to report selection and imaging of vessels arising from the subclavian artery (such as the thyrocervical and costocervical trunks and branches) that supply the neck and shoulder region in addition to vertebral angiography. Code 36218 may only be reported in addition to CPT codes 36225 and 36226 (vertebral angiography) along with prior codes 36216 and 36217.

•       36218 (Revised) Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate).
•       75774 (Revised) Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (List separately in addition to code for primary procedure), with cervicocerebral angiography.

 

Interventional Radiology - Instructions and Reporting

 

Previously the descriptions of codes 37236-37237 stated that they were not to be used for lower extremity procedures. Now, however, the descriptions have been revised to indicate that they are not to be used in the lower extremities "for occlusive disease." This suggests that these codes may be allowed when a stent is placed in the lower extremity for reasons other than occlusive disease-for example, for a popliteal aneurysm. The guidelines in the CPT� manual should clarify this point when they become available.

•       37236 (Revised) Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery
•       37237 (Revised) Each additional artery (List separately in addition to code for primary procedure)

 

Radiation Therapy

 

RT codes underwent significant changes for 2015. Teletherapy isodose planning and brachytherapy codes now include the basic dosimetry calculation and IMRT codes now include guidance and tracking. Also, radiation treatment delivery codes were deleted in 2015.

•       77306 (Revised) Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)
•       77307 (Revised) Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)
•       77316 (Revised) Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)
•       77317 (Revised) Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)
•       77318 (Revised) Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s)
•       77385 (Revised) Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple
•       77386 (Revised) Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex
•       77387 (Revised) Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed

 

Additional New Codes

•       27279 (New) Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device
•       45399 (New) Unlisted procedure, colon
•       91200 (New) Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report

 

Removal of Esophageal Foreign Body

 

A new footnote has been added to the codes for esophageal manipulation to use codes 43499 and 74235 for removal of an esophageal foreign body using a balloon catheter.

 

Spine and Spinal Cord

 

A new introductory paragraph has been added stating that injection of contrast material is included in most of the injection, drainage, and aspiration CPT codes. Also, imaging guidance and injection of contrast are included in the new bundled codes for myelography.

•       27370 (Revised) Injection of contrast for knee arthrography
•       27280 (Revised) Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation, when performed
•       44799 (Revised) Unlisted procedure, small intestine
•       36469  (Deleted) Single or multiple injections of sclerosing solutions, spider veins (telangiectasia); face
•       Surgery Guidelines (Revised) In the guidelines for the Surgery section of the CPT� manual, the definition of the surgical package has been revised. It previously stated that the component services, such as local anesthesia, "are always included in addition to the operation per se." The new version states that the package includes the component services "related to the surgery when furnished by the physician or other qualified health care professional who performs the surgery. "Additionally, the guidelines previously listed "one related Evaluation and Management" service, but for 2015 the limit of one has been removed."

 

New Modifiers - New Distinct Procedural Service Modifiers

 

The August CMS Change Request 8863 establishes four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a "Distinct Procedural Service" effective January 1, 2015. CMS will not stop recognizing the -59 modifier but notes that CPT instructions state that the -59 modifier should not be used when a more descriptive modifier is available. CMS will continue to recognize the -59 modifier in many instances but may selectively require a more specific - X{EPSU} modifier for billing certain codes at high risk for incorrect billing. 

•       XE - Separate Encounter A service that is distinct because it occurred during a separate encounter.
•       XS - Separate Structure A service that is distinct because it was performed on a separate organ/structure.
•       XP - Separate Practitioner A service that is distinct because it was performed by a different practitioner.
•       XU - Unusual Non-Overlapping Service The use of a service that is distinct because it does not overlap usual components of the main service.

 

Radiostereometric Analysis

 

New Category III Codes have been introduced.

•       0348T (New) Radiologic examination, radiostereometric analysis (RSA); spine, (includes cervical, thoracic and lumbosacral, when performed)
•       0349T (New) Radiologic examination, radiostereometric analysis (RSA); upper extremity(ies), (includes shoulder, elbow, and wrist, when performed)
•       0350T (New) Radiologic examination, radiostereometric analysis (RSA); lower extremity(ies)(includes hip, proximal femur, knee, and ankle, when performed)

 

New Category III Codes

•       0331T (New) Myocardial sympathetic innervation imaging,planar qualitative and quantitative assessment
•       0332T (New) Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment; with tomographic SPECT. For myocardial infarct avid imaging, see 78466, 78468, 78469.
•       0338T (New) Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast injection(s), intraprocedural roadmapping and radiological supervision and interpretation, including pressure gradient measurements, flush aortogram and diagnostic renal angiography when performed; unilateral 0339T bilateral. Do not report 0338T, 0339T in conjunction with 36251, 36252, 36253, 36254.
•       0340T (New) Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance. Do not report code 0340T in conjunction with 76940, 77013, 77022.
•       0346T (New) Ultrasound, elastography. List separately in addition to code for primary procedure. Use 0346T in conjunction with 76536, 76604, 76645, 76700, 76705, 76770, 76775, 76830, 76856, 76857, 76870, 76872, 76881, 76882. For elastography without other imaging procedures, use unlisted code.

 

Category III Codes Extended

 

The following category III codes have been extended for another five years.

•       0071T (Extended) Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total  leiomyomata volume less than 200 cc of tissue
•       0072T (Extended) Total leiomyomata volume greater or equal to 200 cc of tissue respectively