Code bundling has become a commonly used tool for revising reimbursement levels for medical services believed to be over- or undervalued. Next year will bring a number of changes in CPT codes.
In the radiology section (70010-79999) of the 2016 CPT book, a preliminary review shows that the American Medical Association (AMA) made a total of 60 changes. Specifically, there are 21 additions, 14 revisions, and 25 deletions.
Jeff Majchrzak of Panacea Healthcare Solutions.According to the American College of Radiology (ACR), many of the new codes are "the result of bundling requests from the AMA's Relativity Assessment Workgroup (RAW) for the purpose of identifying potentially misvalued services."
The ACR Radiology Coding Source article (March-April 2015) further explains that "there were a number of radiology and radiation oncology code pairs identified as being performed together 75% or more of the time and, therefore, referred to the CPT Editorial Panel for bundling in 2016."
In addition to the diagnostic radiology and interventional radiology revisions highlighted below, there is one revision in the breast, mammography subsection, and there is one revision and two additions in the nuclear medicine subsection.
Diagnostic radiology
Changes are scattered throughout the diagnostic imaging section, and several were made so that providers could more easily determine the appropriate code. The subsection with the highest number of changes is lower extremities, but there also are changes in other subsections, specifically:
- Head and neck: one deletion (laryngogram)
- Spine and pelvis: three deletions and four additions
- Urinary tract: two deletions
- Gynecologic and obstetric: two additions
- Vascular procedures: five deletions
Lower extremities
Currently, there is much head-scratching as well as seemingly contradictory information relative to coding for pelvis and hip x-rays. AMA hopes that the CPT 2016 changes will rectify the situation.
Three of the code additions cover "radiological examination, hip, unilateral, with pelvis when performed" -- with selections for one view, two to three views, or a minimum of four views. Another three additions cover bilateral exams, with selections for two views, three to four views, or a minimum of five views. The final two additions focus on the femur exam with either one or two views.
The above code additions will be used instead of the following, which have been deleted for 2016: 73500, 73510, 73520, 73530, 73540, and 73550.
Spine and pelvis
Like the codes for the hip and pelvis, AMA also made changes to the thoracolumbar codes (i.e., for scoliosis) for easier determination of the appropriate code. These changes will, hopefully, resolve the confusion caused by current (but deleted for 2016) code 72010 -- radiologic examination, spine, entire, survey study, anteroposterior and lateral. Although this code appears to be a two-view exam (entire spine, anteroposterior and lateral), it could actually have been assigned for up to six images.
Coders are also confused by codes 72069 and 72090, which are used to report exams for a standing thoracolumbar exam (that does not state the number of views) and a scoliosis study including supine and upright studies (but not stating the number of views):
- 72069: Radiologic examination, spine, thoracolumbar, standing (scoliosis)
- 72080: Radiologic examination, spine; thoracolumbar, two views
- 72090: Radiologic examination, spine; scoliosis study, including supine and erect studies
To resolve the confusion, AMA deleted codes 72010, 72069, and 72090. The new codes (similar to previous changes made to other plain-film radiology procedures) are based strictly on the number of thoracic and lumbar views, and include the rest of the spine if performed (so these cover 72010 as well as the thoracolumbar codes).
- 72081: Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (e.g., scoliosis evaluation); one view
- 72082: Two or three views
- 72083: Four or five views
- 72084: Minimum of six views
A revision was made to the following code. New descriptor text appears in italics and is underlined for emphasis.
- 72080: Radiologic examination, spine; thoracolumbar junction, minimum of two views
Interventional radiology
AMA continues to reverse interventional radiology's "component coding" by combining surgical procedure codes and imaging codes (i.e., supervision and interpretation, or S&I) into a single, complete procedure code.
For example, radiologists should be sure to review the new combination codes in the surgery/urinary system subsection and in the surgery/digestive system subsection under "biliary tract." In the second example, AMA deleted codes 47500-47530, 47560-47561, and 47630, and it added 14 new codes, starting with 47531 and ending with 47544.
Similar to the new genitourinary codes above, these new codes combine the percutaneous surgical procedure code with the imaging (S&I) code. They also include combinations for standalone diagnostic procedures, as well as diagnostic procedures with therapeutic biliary drainage catheter or stent placement, exchange, or removal; biopsies; biliary dilation; and biliary calculus removal.
Introductory guidelines
For 2016, the surgery section includes the following new guideline:
Imaging guidance
When imaging guidance or imaging supervision and interpretation is included in a surgical procedure, guidelines for image documentation and report included in the guidelines for radiology (including nuclear medicine and diagnostic ultrasound) will apply.
AMA revised the radiology section introductory guidelines under "Written Report" as shown in italics and underlined below:
A written report (e.g., handwritten or electronic) signed by the interpreting individual should be considered an integral part of a radiologic procedure or interpretation. With regard to CPT descriptors for radiography services, "images" refer to those acquired in either an analog (i.e., film) or digital (i.e., electronic) manner.
No final RVUs yet
Note, however, that the final relative value units (RVUs) for the codes will not be known until the U.S. Centers for Medicare and Medicaid Services (CMS) publishes the 2016 Medicare Physician Fee Schedule final rule, which usually occurs in November.
Jeff Majchrzak is vice president of clinical consulting services, radiology, for Panacea Healthcare Solutions. In his role as consultant, he conducts CPT coding assessments for both hospitals and physicians, evaluates administrative policies and procedures, and helps develop quality assurance programs to ensure complete and compliant coding and billing. Jeff trains both radiology and cardiology staff (on both technical and professional billing issues) in correct coding practices. Jeff contributes to numerous publications by MedLearn Publishing (a division of Panacea) and is a sought-after national speaker on coding and reimbursement for radiology, interventional radiology, nuclear medicine, and cardiology. Jeff can be reached at [email protected], or visit Panacea Healthcare Solutions at www.panaceahealthsolutions.com.
The comments and observations expressed herein are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
