Medicare is constantly on the lookout for procedure codes that it feels do not reflect the current cost or complexity of practice. The annual Medicare Physician Fee Schedule (MPFS) rule modifies many codes, with varying degrees of effect for radiology practices.
Richard Morris.Although the U.S. Centers for Medicare and Medicaid Services (CMS) estimates no change for diagnostic and interventional radiology due to the 2019 MPFS proposed rule, there are large increases and decreases in individual codes. For example, the placement of peripherally inserted central catheter (PICC) lines is an important procedure for interventional radiologists, and it is facing a 57% decrease.
We present here some of the largest decreases and increases in the proposed rule so practices can evaluate for themselves what might happen next year.
Diagnostic radiology
Here is a summary of the changes to radiology (70000-series) procedures in the 2019 MPFS proposed rule.
| No. of procedures with changes | ||
| Professional component | Global | |
| Decrease of 1% or more | 201 | 213 |
| Increase of 1% or more | 47 | 187 |
| Change of less than 1% | 342 | 150 |
| Total procedure codes | 590 | 550 |
More procedures are proposed for reduced reimbursement than an increase. In the professional component list, eight procedures face a decrease of 16% to 20%, although half of these are ophthalmologic exams that are performed infrequently. The others are spine and neck x-rays, as shown below.
| Select procedures with decrease of 16%-20% | ||||
| Description | CPT code | 2018 rate | 2019 rate | Increase (decrease) |
| Neck spine 4/5 views | 72050 | $16.20 | $12.98 | (19.9%) |
| L-2 spine 4/> views | 72110 | $16.20 | $12.98 | (19.9%) |
| Neck spine 6/> views | 72052 | $18.72 | $15.14 | (19.1%) |
| L-S spine bending | 72114 | $16.92 | $13.70 | (19.0%) |
Twenty-seven global codes are proposed to be cut by 10% to 20% for 2019. Again, some are ophthalmologic exams, but quite a few CT and MRI procedures are included as well.
| Select procedures with decrease of 10%-20% | ||||
| Description | CPT code | 2018 rate | 2019 rate | Increase (decrease) |
| MRA head w/wo | 70546 | $493.19 | $414.53 | (15.9%) |
| MRA neck w/wo | 70549 | $512.63 | $434.36 | (15.3%) |
| CT abdomen/pelvis | 74178 | $288.00 | $247.28 | (14.1%) |
| CTA lower extremity | 73706 | $349.56 | $300.54 | (14.0%) |
| CTA abdominal arteries | 75635 | $374.04 | $324.69 | (13.2%) |
| CTA heart w/ 3D imaging | 75574 | $373.68 | $324.69 | (13.1%) |
| CT colonography | 74262 | $380.88 | $331.90 | (12.9%) |
| CT heart w/ 3D congenital | 75573 | $381.60 | $332.62 | (12.8%) |
| MRI chest w/wo | 71552 | $572.03 | $504.77 | (11.8%) |
| CTA upper extremity | 73206 | $334.08 | $296.21 | (11.3%) |
| MRA head w/ contrast | 70545 | $314.28 | $279.72 | (11.0%) |
| MRI lower extremity w/o | 73718 | $301.68 | $269.27 | (10.7%) |
On the positive side, 16 professional component procedures and 50 global procedures could increase by 10% or more. Notice, however, that some procedures with large global fee increases had decreases for the professional component. Some highlights are listed below.
| Select procedures with increase of at least 10% | |||
| Description | CPT code | Professional component | Global |
| Spine x-ray 1 view | 72020 | 50.2% | 25.6% |
| Elbow x-ray 2 views | 73070 | 48.0% | 14.4% |
| Heel x-ray | 73650 | 43.7% | 11.8% |
| Forearm x-ray | 73090 | 37.7% | 24.8% |
| Elbow x-ray 3+ views | 73080 | 32.2% | 4.6% |
| Sacrum tailbone x-ray | 72220 | 32.2% | 21.4% |
| Sacroiliac joints x-ray <3 views | 72200 | 32.2% | 21.4% |
| Sacroiliac joints x-ray 3+ views | 72202 | 18.7% | 13.0% |
| CT for needle biopsy | 77012 | 28.4% | 22.0% |
| MRA upper extremity w/wo | 73225 | (0.7%) | 17.5% |
| MRA spine w/wo | 72159 | 0.5% | 17.5% |
| DXA peripheral | 77081 | (6.3%) | 20.2% |
| Ultrasound AAA screening | 76706 | 0.1% | 19.5% |
| Ultrasound transrectal | 76872 | (3.0%) | 28.5% |
Interventional radiology
Many interventional radiology (IR) procedures are coded outside the 70000-series of CPT codes. Of the 661 codes that are relevant to radiology, according to the American College of Radiology's impact table, 255 will increase by 1% or more while 232 will decrease by 1% or more. Here are some examples at the far ends of that spectrum.
| Select IR procedures with changes | ||
| Description | CPT code | Increase (decrease) |
| Insert PICC catheter < age 5 | 36569 | (61.3%) |
| Insert PICC catheter age 5+ | 36568 | (57.2%) |
| Fine needle aspiration w/o imaging | 10021 | (21.8%) |
| Exchange nephrostomy catheter | 50435 | 10.4% |
| Cystoscopy | 52000 | 11.6% |
| Injection for cholangiogram | 47531 | 11.7% |
| Removal of biliary drainage catheter | 47537 | 12.1% |
| Replace PICC catheter | 36584 | 70.4% |
Conclusion
A huge increase or reduction for a procedure that is rarely done has little impact on the practice's overall revenue, but changes to high-volume procedures have to be viewed more carefully. Some revision of the proposed procedure valuation changes can take place before the 2019 fee schedule is finalized in November. We will continue to monitor and report on significant events that will affect your practice.
Richard Morris is the director of value-based strategy for Healthcare Administrative Partners.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
