2022 Coding Changes Preview Arrives for Radiology

Several changes and revisions are expected for radiology coding and guidelines come 2022. In an online posting titled “CPT 2022 Anticipated Code Changes,” the American College of Radiology (ACR) outlined a preliminary guide of changes that radiology providers should know for 2022. However, be aware that the code changes listed in the article are not yet final. Rather, they reflect the actions taken by the CPT Editorial Panel at the time. Presented is an outline of the potential changes that radiology providers, physicians, CPT^® coders, and healthcare regulatory and compliance teams should be aware of for the 2022 update season. 

As a reminder, there are three types of CPT codes:

• Category I: Procedures that are consistent with contemporary medical practice and are widely performed.
  
• Category II: Supplementary tracking codes that can be used for performance measures.
  
• Category III: Temporary codes for emerging technology, services, and procedures. These codes help foster more thorough and efficient documentation and help with proper utilization and reporting of new technologies.

Understand that new category III codes were introduced within the Radiology section of the Current Procedural Terminology 2021 code set along with the addition of new codes effective in 2022. Furthermore, two early release Category III codes will be available for use in July 2021.

Among the early release codes, category III codes were established to detail the use of  new and emerging technologies in the following:

• breast computed tomography (CT)
• quantitative multiparametric magnetic resonance imaging (mp-MRI)
• percutaneous allogeneic injection of the lumbar spine
• automated advanced coronary analysis.

Effective in 2022, category I and category III codes were established for reporting:

• trabecular bone score (TBS)
• thermal destruction of the intraosseous basivertebral nerve
• quantitative ultrasound tissue characterization (non-elastographic)
• and artificial intelligence (AI) analysis for the detection of vertebral fractures.

• Breast Computed Tomography Coding Changes

Expect to see six codes added for breast computed tomography. These codes, 0633T-0638T, were created within the CPT 2021 code set. This includes three unilateral codes, three bilateral codes for detailing breast CT without contrast, breast CT with contrast, and breast CT without and with contrast.

Before May 2020, according to the ACR,  no CPT codes existed for reporting breast CT. The ACR notes that “Existing chest CT and CT angiography (CTA) imaging and equipment optimization for detection of breast lesions are sufficiently different than conventional chest CT to justify the creation of a separate Category III coding family.”

• Percutaneous Lumbar Spine Allogeneic Injection Updates

Added to the CPT 2021 code set are four codes, 0627-0630T, established in the CPT 2021 code set for detailing percutaneous injection of allogeneic cellular and/or tissue-based products. Understand that percutaneous allogeneic injection of the lumbar spine is a new therapeutic procedure. This procedure is conducted through imaging-guided injection of the lumbar spine by using allogeneic cellular and/or tissue-based products to replace or supplement the disc tissue or cells allowing for repair or reconstitution of damaged intravertebral disc(s).

• Automated Advanced Coronary Analysis Additions

Now available for reporting, 0623T–0626T were established to detail the use of automated quantification and characterization of coronary atherosclerotic plaque applying raw data obtained from CCTA. Note that guidelines in the Diagnostic Radiology section also received revisions and were updated to include these new codes. Understand that “Automated advanced coronary analysis uses computer algorithms to provide additional analysis of coronary CTA (CCTA) beyond the conventional interpretation of CCTA.”

Early Release Category III Codes

Some codes were released in December 2020. Understand that these codes will have an effective date of July 1, 2021. These codes will also be made available on the AMA’s website.

Two codes were created for Quantitative mp-MRI Two codes (0648T, 0649T) to report quantitative mp-MRI for the analysis of tissue composition, including multiparametric data acquisition, data preparation and transmission, and interpretation and report that is obtained either with or without a concurrent diagnostic MRI.

Being that quantitative mp-MRI is a new technology, it does not presently have a CPT code established. Understand that quantitative mp-MRI utilizes software to evaluate tissue physiology of visceral organs and other anatomic structures non-invasively, and acts to provide assistance in physician decision-making.

Category I Code Additions for CPT 2022

Effective as of January 1, 2022, expect to see new category I radiology diagnostic codes included in the CPT 2022 code set.

• Diagnostic Radiology: Trabecular Bone Score Changes

Trabecular bone score (TBS) will see the arrival of the four new codes for reporting. Understand that TBS provides measurements for the structural condition of the bone micro-architecture. This intern allows for better predictions of potential risks for major osteoporotic fracture independent of bone mineral density (BMD) and associated clinical risk factors.

• Diagnostic Radiology: Destruction of Intraosseous Basivertebral Nerve Additions

Expect to see two new codes to arrive for thermal destruction of the intraosseous basivertebral nerve. The new procedure detailed in the code offers chronic low-back pain relief for patients. Watch out for a new parenthetical note alerting users that these new codes will be included in the Percutaneous Vertebroplasty and Vertebral Augmentation subsection of the Musculoskeletal section of the CPT 2022 code set.

Stay tuned for further insight and analysis as more news becomes available on both coding and regulation for 2022. Master obstacles with more monthly insight into compliance and coding challenges through our Radiology Compliance Manager Newsletter.