American Medical Association is ready with radiology coding changes as it happens every year. Certain codes are deleted and added or revised with a view to reflect current techniques, technologies also services. In 2021, radiology coding changes are very few. New codes assigned for radiology is also limited.

Last year on September 1, 2020, American Medical Association (AMA) and Current Procedural Terminology (CPT) had approved changes to CPT and HCPCS coding structure. Those changes are expected to be implemented from 2021. Usually as a part of mid-year program, American College of Radiology encourages groups to implement new radiology category III codes. These new radiology coding updates affect irreversible electroporation, ablation and magnetic resonance spectroscopy.

Diagnostic Radiology Coding Changes:

CT Screening of Thorax:

  • The diagnostic codes used are 71250, 71260 and 71270. It’s evident that new CT thorax code will also be available to report low dose lung cancer screening.
  • G0297 is the current HCPCS code that was identified by CMS and was subsequently referred to editorial panel in order to report low dose CT for lung cancer screening.

Urography:

  • 74425 is the radiology code used for Diagnostic Radiology Procedures of the Urinary Tract and is going to be revised by adding clarification to a reciprocal parenthetical which can be reported with radiology coding 50390, 50396, 50684, and 50690.

Fluoroscopic Guidance:

  • In radiology coding, codes 64400-64450 and 64455 is added in the inclusionary parenthetical notes by following Codes 77002 and 77003 – Fluoroscopic Guidance.

Ultrasound Follow-Up Study:

  • Radiology code 76970 for other Diagnostic Ultrasound Procedure that has been referred to the CPT Editorial Panel for deleted codes due to low volume.

Interventional Radiology coding changes:

Percutaneous Core Needle Lung Biopsy:

  • For the above procedure, radiology code 32405 Under Excision Procedures of the Lungs and Pleura is going to be deleted and will be replaced with new code that bundles percutaneous core needle lung biopsy with imaging guidance after performance.
  • Especially the codes 32405 and 77012 we’re mentioned by editorial panel as code pairs which performs together almost 75% of the time. Additionally they were also identified as bundled.

Medical Physics:

Medical Physics Dose Evaluation:

  • A new category I radiology code involves Diagnostic Radiology, Diagnostic Imaging, other Procedures subsection of the CPT to report the assessment and calculation of radiation dose, and the potential adverse iatrogenic effects received by the patient where follow up is required for observation and treatment.

Evaluation and Management:

  • For E/M visits: The approval of significant revisions to E/M code descriptors was the first to begin by editorial panel. To the matter of fact, this is considered to be the first major growth E/M reporting in 25 years.
  • Those changes involve:
  1. The elimination of history and physical exam especially for code selection and reduction of administrative burden.
  2. It allows healthcare professionals to decide between medical decision making and total time to determine.
  3. It also modifies MDM criteria in order to affect the management of patient’s health condition.
  4. To ensure payment levels for outpatient E/M code visits which actually are resource based.
  5. To simplify and minimize the requirements for audits.
  6. Most importantly, to reflect the provided services.

As per radiology coding and new E/M code structure, new add-on code is created to report additional provider time in 15-minute increments.

This new add-on code is reported with codes 99205 and 99215 along with other changes those include:

  • Deletion of new patient code 99201
  • Revision of new patient codes 99202, 99203, 99204, and 99205, and established patient codes 99211, 99212, 99213, 99214, and 99215.
  • Those prolonged services codes 99354, 99355, and 99356 can be revised to reflect these changes.

Radiology Coding for Lung Cancer:

Deleted codes:

  • G0297- This code is used for Low dose CT scan (LDCT) for lung cancer screening

New codes:

  • 71271 – This code is used for Computed tomography (CT), thorax, low dose for lung cancer screening, without contrast material.

Thorax CT Screening Codes:

  • 71250 – This code is for Computed tomography, thorax, diagnostic; without contrast material
  • 71260 – This code is for Computed tomography, thorax, and diagnostic; with contrast material.
  • 71270 – This code is used for Computed tomography, thorax, and diagnostic; without contrast material, followed by contrast material and further sections.

Radiology coding for Urography:

  • It’s supposed to be revised Codes for 2021, 74425 – Urography, ante grade, radiological supervision and interpretation.

Biopsy:

Deleted codes:

  • 32405 – Biopsy, lung or mediastinum, percutaneous needle.

New codes:

  • 32408 – Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, during Interventional Radiology and procedures.

Interventional Radiology

Deleted codes:

  • 0228T – Injection, anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic, single level
  • 0229T – Injections, anesthetic agent or steroid, transforaminal epidural, with Ultrasound guidance, cervical or thoracic, each additional level
  • 0230T – Injections, anesthetic agent and steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral, single level
  • 0231T – Injections, anesthetic agent and steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral, each additional level.

New codes:

  • 0620T – Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterizations and intraprocedural roadmapping and imaging guidance required to complete the intervention, all associated radiological supervision and interpretation, during performance.
  • 55880 – Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance.

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