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As you may know from our previous insights, new category III codes were officially effective on January 1, 2022. With these codes now active, interventional radiology providers and stakeholders should be aware of the scope of changes in place for the new year. By understanding the changes, staff and coders can prepare for a successful year while safeguarding compliance. In this insight, we continue exploring must know category III coding that could impact your facility.

Percutaneous Ultrasound Guided Gastrotomy Tube Placement

0647T was created with the goal of incorporating percutaneous access for G tube placement using magnets to bring the stomach to the wall with ultrasonic guidance.

0647TInsertion of gastrostomy tube, percutaneous, with magnetic gastropexy, under ultrasound guidance, image documentation and report

When only performing ultrasonic guidance and without the magnet, remember to report the normal G code. You should not report 76942 with 0647T or report 0647T in conjunction with 76942. The following is a clinical example:

0647T Clinical Example ( Changes 2022)

HISTORY:
75 year old male presents with cerebral infarction. Inability to eat. Request G tube placement for nutrition.

DESCRIPTION OF PROCEDURE:
Introduce the balloon catheter with internal magnet via mouth to the stomach. Insufflate the stomach with air. Place second magnet atop the abdomen which is attracted to the catheter’s magnet in the stomach. Fill the balloon with saline. Use ultrasound to visualize the intervening tissue and find a safe tract. Use the external magnet to adjust positioning. Puncture the abdomen to place the guidewire and capture the guidewire by deflating the balloon. Remove the guiding catheter out of the mouth and place the gastrostomy tube.

Prostate Laser Ablation

0655T is usually performed by a urologist in the operating room, however, it may be performed by an interventional radiologist. If not, the radiology department must understand that the imaging is included and not separately billed.

0655TTransperineal focal laser ablation of malignant prostate tissue, including transrectal imaging guidance, with MR-fused images or other enhanced ultrasound imaging

Understand that this code encompasses laser ablation of malignant prostate tissue, with transrectal imaging guidance. MR-fused ultrasound or other enhanced ultrasound imaging will be used with this procedure. It is important to note that this code should not be reported in conjunction with 52000, 76376, 76377, 76872, 76940, 76942, 76998.

Understand that a new category III code was created to incorporate percutaneous thyroid laser ablation using imaging guidance.

0673TAblation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance

This code should be billed once per session regardless of how many thyroid nodules are ablated by laser. Understand that imaging guidance codes (76940, 76942, 77013, 77022) are inclusive and not separately reportable. The following is a clinical example for 0673T:

0673T Clinical Example (CPT Changes 2022)

HISTORY:
Patient presents with thyroid nodule in the lower pole of the right lobe.

DESCRIPTION OF PROCEDURE:
Use ultrasound to localize the target lesion. Introduce one or more needles into the lesion. Place the optical fiber(s) into the introducer needle. Deliver laser energy to the target lesion(s). Monitor progress via ultrasound.

Histotripsy

This code encompasses a new ablative technique using acoustic energy that is generated by a transducer. It is closer to lithotripsy than high-intense ultrasound. 0686T creates cavitation in the tumor.

0686THistotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant hepatocellular

The procedure behind the code is created to treat liver tumors/lesions Understand that this code does not use thermal energy. However, note that this code includes all imaging guidance. The following is a clinical example:

0686T Clinical Example (CPT Changes 2022)

HISTORY:
66 year old male diagnosed with hepatocellular carcinoma and is not a surgical candidate.

DESCRIPTION OF PROCEDURE:
Patient is placed in the supine position. Perform computer-assisted targeting and dosing calculations. Perform histotripsy (nonthermal tumor ablation using acoustic energy) under ultrasound.

These are not all the coding updates impacting interventional radiology. Explore more coding knowledge and additional pressing topics to master compliance and coding with our 2022 Radiology Coding Update on-demand webcast.

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