It seems impossible that a new year is just a few weeks away, yet here it comes along with numerous changes we’ve anticipated throughout the year. As we get closer to January 1st, it’s critical to ensure all staff have a complete understanding of the code changes impacting radiology in the new year. Below is a quick review of some notable changes to be aware of and prepare staff for.
The code series for radiologic examination of the GI tract (74210–74251) has undergone significant changes to align more closely with other codes in the radiology code set, and to more clearly define the anatomic region being imaged while specifying the components included in the exam. Two new codes were added, one primary code (74221) and one add-on code (+74248), while five codes were deleted (74241, 74245, 74247, 74249, 74260).
| 74221 | Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study |
| 74248 | Radiologic small intestine follow-through study, including multiple serial images (List separately in addition to code for primary procedure for upper GI radiologic examination) |
Additionally, nine codes (74210, 74220, 74230, 74240, 74246, 74250, 74251, 74270, 74280) received description revisions, as mentioned above, to add greater clarity and specificity for the areas being imaged and the components of the exams. The below examples show the difference between a few of the 2019 and 2020 long code descriptions.
| Code | 2019 Long Description | 2020 Long Description |
| 74210 | Radiologic examination; pharynx and/or cervical esophagus | Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study |
| 74240 | Radiologic examination, gastrointestinal tract, upper; with or without delayed images, without KUB | Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study |
| 74250 | Radiologic examination, small intestine, includes multiple serial images; | Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; single-contrast (eg, barium) study |
With significant revisions, there are also revised parenthetical notes throughout this section. Be sure to closely review the latest CPT® manual to ensure codes are being applied correctly.
We have been anticipating changes to nuclear medicine codes for a while, and 2020 has delivered with major changes to myocardial PET and the “Other Procedures” section of Nuclear Medicine.
Other Procedures
The changes to this section included the deletion of nine codes, including most of the anatomic site-specific SPECT codes, and the introduction of a new set of generic codes to describe radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) – specifying the type of imaging (planar, SPECT, SPECT/CT) performed, the number of areas imaged (i.e., one area, two or more areas vs. organ/site specific) and the number of days over which the imaging takes place.
Four new codes have been added (78830, 78831, 78832, 78835) and five have undergone significant description revisions (78800, 78801, 78802, 78804, 78803).
Myocardial PET
Following the trend we have been seeing with imaging codes, the code series for myocardial PET was updated to include and specify component services of myocardial PET. Codes 78459, 78491 and 78492 were updated to include ventricular wall motion and ejection fraction when performed. Five new codes (78429, 78430, 78431, 78432, 78433) were added to describe myocardial PET metabolic evaluation studies, perfusion studies, or combination perfusion and metabolic evaluation studies with or without concurrently acquired CT.
Category III code 0482T (absolute quantification of myocardial blood flow) was deleted and replaced with new code +78434.
Code G0365 has been deleted for 2020 and replaced with two new codes (93985, 93986) that describe a duplex scan of arterial inflow and venous outflow to assess vessels prior to the creation of a hemodialysis access. Be sure to watch for revisions to parenthetical notes with the addition of these codes.
Now more than ever, it’s important to be fully informed with the new year coming up so quickly. With the whirlwind of changes coming, working with outdated or incomplete information is not worth the risk. Keep an eye on the latest news coming out of the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA), specialty societies and other sources as we learn more about the guidelines and requirements for these changes.
Prominent interventional radiology coding expert Jeff Majchrzak, BA, RCC, CIRCC breaks down everything you need to know concerning radiology coding in the new year with our annual Radiology Coding Update. This two and a half-hour session provides in-depth guidance through all the changes: what they are, the impact on your facility and how to apply them. Jeff will walk you through strategies to prevent miscoding and noncompliant billing. In short, do not miss this once-a-year opportunity to solidify your understanding of the changes and ensure compliance in the new year!
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