As has been the case in the past several years, the phrase "potentially misvalued services" will play a key role in the changes that will be made by the American Medical Association (AMA) to the 2017 current procedural terminology (CPT) codes. Specifically, code pairs identified as being performed together at least 75% of the time will likely be bundled.
"A number of new codes and guideline revisions will be implemented for 2017 ... as a result of bundling mandates from the AMA's Relativity Assessment Workgroup (RAW) for the purpose of identifying potentially misvalued services," according to an American College of Radiology (ACR) Radiology Coding Source article.
Jeff Majchrzak of Panacea Healthcare Solutions.In the article, the ACR gives examples of procedures referred to the CPT Editorial Panel for bundling next year, as well as a preliminary overview of other changes that are likely to occur, including those highlighted below.
Mammography and CAD
According to the ACR, three new CPT codes have been proposed to bundle computer-aided detection (CAD) with screening and diagnostic mammography. The following CAD and mammography codes would be deleted:
- +77051: CAD (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (list separately in addition to code for primary procedure)
- +77052: Screening mammography (list separately in addition to code for primary procedure)
- 77055: Mammography; unilateral
- 77056: Mammography; bilateral
- 77057: Screening mammography, bilateral (2-view study of each breast)
The ACR also expects the U.S. Centers for Medicare and Medicaid Services (CMS) to delete the following Healthcare Common Procedure Coding System (HCPCS) level II codes:
- G0202: Screening mammography, producing direct digital image, bilateral, all views
- G0204: Diagnostic mammography, producing direct 2D digital image, bilateral, all views
- G0206: Diagnostic mammography, producing direct 2D digital image, unilateral, all views
Interventional radiology
There likely will be a variety of new codes and deleted codes in this section of CPT. In its summary, the ACR reported the following:
- New bundled codes are proposed to report dialysis circuit angiography, angioplasty, stent placement, thrombectomy, and embolization to address the work related to dialysis circuit diagnosis and interventions.
- The Joint CPT/Specialty Society Relative Value Scale Update Committee (RUC) Workgroup identified the following codes as being frequently reported together in various combinations: 35475, 35476, 36147, 36148, 36870, 37236, 37238, 75791, 75962, and 75968. Six of these codes are proposed for deletion: 35475, 35476, 36147, 36148, 36870, and 75791.
- New codes will be created to capture all current uses of the following codes, which are marked for deletion: percutaneous transluminal balloon angioplasty codes 35471, 35472, 35475, and 35476, along with open transluminal balloon angioplasty codes 35450, 35452, 35458, and 35460 and their related radiologic imaging services codes 75962, 75964, 75966, 75968, and 75978.
- Also proposed is the revision, deletion, and renumbering of epidural injection codes 62310, 62311, 62318, and 62319 that exclude imaging, revision of fluoroscopic guidance instructions related to these injections, and the addition of new codes to bundle imaging guidance.
- New codes will be added to report nontumescent, mechanochemical treatment of extremity vein incompetence, and current codes 36476 and 37479 will be revised to describe the additional veins treated.
Category III codes
The AMA defines category III codes as temporary codes for emerging technology, services, and procedures. Unlike the unlisted codes, these codes allow collection of more specific data. If a category III code is available, it must be reported instead of an unlisted code.
The ACR noted the following possible changes:
- Deletion of code G0389 -- ultrasound B-scan and/or real-time with image documentation; for abdominal aortic aneurysm (AAA) screening -- with a new CPT category I code replacing it.
- Creation of new category III codes to describe percutaneous cryoablation of phantom limb pain and tactile breast imaging by computer-aided sensors for use in the primary care setting as augmentation of the clinical breast exam.
- Extension (currently marked to be retired in 2017) of the following until the procedures or services have met the criteria for category I status: 0159T, 0174T, 0175T, and 0281T.
In August, the AMA will provide an early release of a downloadable version of the CPT 2017 code book from its bookstore. The CMS-approved values for codes, however, will not be known until the Medicare Physician Fee Schedule Final Rule is published in the Federal Register, typically 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.
