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Old 09-20-2012, 09:07 AM
chembree chembree is offline
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Default 2013 new CPT codes (Radiology)

The CPT coding changes for 2013 have been released. Understanding the new codes is crucial to obtaining the proper reimbursement for your services and ADVOCATE has analyzed the changes and provided the highlights below.

CPT 2013 will see changes once again in vascular and non-vascular interventional radiology as well as changes in diagnostic x-ray, 3D reconstruction, and nuclear medicine thyroid imaging. All of the CPT changes are effective with January 1, 2013 dates of service. Below are highlights of the changes that will most commonly affect radiology practices. To view only the Additions, Deletions or Revisions, click the applicable link below.

Additions Deletions Revisions

DIAGNOSTIC RADIOLOGY
Existing codes for bronchography have been deleted.

71040 Bronchography, unilateral, radiological supervision and interpretation

71060 Bronchography, bilateral, radiological supervision and Interpretation

Codes for cervical spine x-rays have been revised, thus simplifying CPT code selection based on the number of views only.

72040 Radiologic examination, spine, cervical; 3 views or less

72050 Radiologic examination, spine, cervical; 4 or 5 views

72052 Radiologic examination, spine, cervical; 6 or more views

3D RECONSTRUCTION
New verbiage has been added to both 3D reconstruction codes, providing clarification that image post-processing must be done under concurrent supervision.

76376 3D rendering with interpretation and reporting of computed tomography,magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation

76377 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation

Per the AMA/ACR Clinical Examples in Radiology, Concurrent physician supervision, as noted in the 3D codes 76376 and 76377, defines a temporal relationship to creating the 3D volume rendered images. Concurrent means active participation in and monitoring of the reconstruction process that includes: design of the anatomic region that is to be reconstructed; determination of the tissue types and actual structures to be displayed (eg, bone, organs, and vessels); determination of the images or cine loops that are to be archived; and monitoring and adjustment of the 3D work product.

Although it is not required to document physician involvement, the ACR recommends that it is best to document the physician's supervision or participation in the 3D reconstruction of images in case of an audit, and to distinguish from those cases where the physician is not involved.


NUCLEAR MEDICINE
New changes will be in effect for nuclear medicine imaging of the thyroid and parathyroid.

Existing CPT code range 78000-78011 describing thyroid nuclear medicine imaging has been replaced by 3 new codes which combine the single and multiple determinations into one code.

78012 Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)

78013 Thyroid imaging (including vascular flow, when performed);

78014 Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)

The existing single code for parathyroid nuclear medicine imaging has been broken out into 3 codes:

78070 Parathyroid planar imaging (including subtraction, when performed);

78071 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT)

78072 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization

RADIATION THERAPY
Two new codes have been added in radiation oncology.

32701 Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment

0301T* Destruction/reduction of malignant breast tumor with externally applied focused microwave, including interstitial placement of disposable catheter with combined temperature monitoring probe and microwave focusing sensocatheter under ultrasound thermotherapy guidance


NONINVASIVE VASCULAR STUDIES
One new code has been added in noninvasive vascular studies.

0311T* Non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report

*Category III codes are temporary codes are are created for emerging technology, services, and procedures. Use of these Category III codes allow data collection for these services and procedures.


VASCULAR INTERVENTIONAL RADIOLOGY

CERVICOCEREBRAL ANGIOGRAPHY
Seemingly the biggest area impacted for 2013 is cervicocerebral angiography. The existing codes and rules for coding these procedures have been revised and/or deleted and new codes which include all catheter placement and imaging have been introduced. This could mean significant revenue impact.

Currently, cervicocerebral angiography procedures may involve any combination of 2 to 8+ CPT codes. The following 8 codes have essentially replaced the reporting of these code combinations with a single code choice.

36221 Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

36222 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

36223 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed

36224 Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed

36225 Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation,includes angiography of the cervicocerebral arch, when performed

36226 Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

36227 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

36228 Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation
and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (List separately in addition to code for primary procedure)

FOREIGN BODY RETRIEVAL
Existing codes 37203 and 75961 describing transcatheter retrieval of intravascular foreign body have been replaced by a single code:

37197 Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), includes radiological supervision and interpretation, and imaging guidance (ultrasound or fluoroscopy), when performed

TRANSCATHETER THERAPY
Existing transcatheter therapy codes for thrombolytic infusion have been replaced by 4 new codes that not only include imaging guidance, but also provide further specification on arterial/venous and initial/ subsequent treatments.

37211 Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day

37212 Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day

37213 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed

37214 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method

As a result of these new codes, the existing codes for angiography with infusion therapy (75896 & 75898) have been revised to clarify that they should not be used for thrombolytic therapy.

Also, existing codes for exchange of intravascular catheter during thrombolytic therapy (37209 & 75900) have been deleted, as this is now included in the new code 37214.


NON-VASCULAR INTERVENTIONAL RADIOLOGY

THORACENTESIS
Following the trend of bundling imaging guidance into new codes, 4 new codes for thoracentesis have been introduced. These codes replace codes 32420-32422.

32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance

32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance

32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance

32557 Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance

In addition, the existing code tube thoracostomy has been revised.

32551 Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure)
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Old 09-20-2012, 09:35 AM
Jim Pawloski Jim Pawloski is offline
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Quote:
Originally Posted by chembree View Post
The CPT coding changes for 2013 have been released. Understanding the new codes is crucial to obtaining the proper reimbursement for your services and ADVOCATE has analyzed the changes and provided the highlights below.

CPT 2013 will see changes once again in vascular and non-vascular interventional radiology as well as changes in diagnostic x-ray, 3D reconstruction, and nuclear medicine thyroid imaging. All of the CPT changes are effective with January 1, 2013 dates of service. Below are highlights of the changes that will most commonly affect radiology practices. To view only the Additions, Deletions or Revisions, click the applicable link below.

Additions Deletions Revisions

DIAGNOSTIC RADIOLOGY
Existing codes for bronchography have been deleted.

71040 Bronchography, unilateral, radiological supervision and interpretation

71060 Bronchography, bilateral, radiological supervision and Interpretation

Codes for cervical spine x-rays have been revised, thus simplifying CPT code selection based on the number of views only.

72040 Radiologic examination, spine, cervical; 3 views or less

72050 Radiologic examination, spine, cervical; 4 or 5 views

72052 Radiologic examination, spine, cervical; 6 or more views

3D RECONSTRUCTION
New verbiage has been added to both 3D reconstruction codes, providing clarification that image post-processing must be done under concurrent supervision.

76376 3D rendering with interpretation and reporting of computed tomography,magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation

76377 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation

Per the AMA/ACR Clinical Examples in Radiology, Concurrent physician supervision, as noted in the 3D codes 76376 and 76377, defines a temporal relationship to creating the 3D volume rendered images. Concurrent means active participation in and monitoring of the reconstruction process that includes: design of the anatomic region that is to be reconstructed; determination of the tissue types and actual structures to be displayed (eg, bone, organs, and vessels); determination of the images or cine loops that are to be archived; and monitoring and adjustment of the 3D work product.

Although it is not required to document physician involvement, the ACR recommends that it is best to document the physician's supervision or participation in the 3D reconstruction of images in case of an audit, and to distinguish from those cases where the physician is not involved.


NUCLEAR MEDICINE
New changes will be in effect for nuclear medicine imaging of the thyroid and parathyroid.

Existing CPT code range 78000-78011 describing thyroid nuclear medicine imaging has been replaced by 3 new codes which combine the single and multiple determinations into one code.

78012 Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)

78013 Thyroid imaging (including vascular flow, when performed);

78014 Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)

The existing single code for parathyroid nuclear medicine imaging has been broken out into 3 codes:

78070 Parathyroid planar imaging (including subtraction, when performed);

78071 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT)

78072 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization

RADIATION THERAPY
Two new codes have been added in radiation oncology.

32701 Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment

0301T* Destruction/reduction of malignant breast tumor with externally applied focused microwave, including interstitial placement of disposable catheter with combined temperature monitoring probe and microwave focusing sensocatheter under ultrasound thermotherapy guidance


NONINVASIVE VASCULAR STUDIES
One new code has been added in noninvasive vascular studies.

0311T* Non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report

*Category III codes are temporary codes are are created for emerging technology, services, and procedures. Use of these Category III codes allow data collection for these services and procedures.


VASCULAR INTERVENTIONAL RADIOLOGY

CERVICOCEREBRAL ANGIOGRAPHY
Seemingly the biggest area impacted for 2013 is cervicocerebral angiography. The existing codes and rules for coding these procedures have been revised and/or deleted and new codes which include all catheter placement and imaging have been introduced. This could mean significant revenue impact.

Currently, cervicocerebral angiography procedures may involve any combination of 2 to 8+ CPT codes. The following 8 codes have essentially replaced the reporting of these code combinations with a single code choice.

36221 Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

36222 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

36223 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed

36224 Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed

36225 Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation,includes angiography of the cervicocerebral arch, when performed

36226 Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

36227 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

36228 Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation
and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (List separately in addition to code for primary procedure)

FOREIGN BODY RETRIEVAL
Existing codes 37203 and 75961 describing transcatheter retrieval of intravascular foreign body have been replaced by a single code:

37197 Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), includes radiological supervision and interpretation, and imaging guidance (ultrasound or fluoroscopy), when performed

TRANSCATHETER THERAPY
Existing transcatheter therapy codes for thrombolytic infusion have been replaced by 4 new codes that not only include imaging guidance, but also provide further specification on arterial/venous and initial/ subsequent treatments.

37211 Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day

37212 Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day

37213 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed

37214 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method

As a result of these new codes, the existing codes for angiography with infusion therapy (75896 & 75898) have been revised to clarify that they should not be used for thrombolytic therapy.

Also, existing codes for exchange of intravascular catheter during thrombolytic therapy (37209 & 75900) have been deleted, as this is now included in the new code 37214.


NON-VASCULAR INTERVENTIONAL RADIOLOGY

THORACENTESIS
Following the trend of bundling imaging guidance into new codes, 4 new codes for thoracentesis have been introduced. These codes replace codes 32420-32422.

32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance

32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance

32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance

32557 Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance

In addition, the existing code tube thoracostomy has been revised.

32551 Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure)
Thank you for the new codes! I know questions of crosswalks will be next.
Jim Pawloski, CIRCC
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Old 11-05-2012, 12:25 PM
debbenson debbenson is offline
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Default RVU and fee schedule

Thanks for the great info. Would you happen to have any information on code 32701 such as RVU and Medicare fee schedule?
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Old 12-14-2012, 04:37 AM
spa spa is offline
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Quote:
Originally Posted by Jim Pawloski View Post
Thank you for the new codes! I know questions of crosswalks will be next.
Jim Pawloski, CIRCC
Do any one know we have to use modifiers LT, RT, 50 for 32554-32557 these are new codes for Thoracentesis.
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Old 12-14-2012, 06:58 AM
donnajrichmond donnajrichmond is offline
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Quote:
Originally Posted by sparimi View Post
Do any one know we have to use modifiers LT, RT, 50 for 32554-32557 these are new codes for Thoracentesis.
If bilateral thoracentesis or chest tubes, then yes you would code twice. Whether to use LT / RT or -50 would depend on individual payer rules.
It doesn't happen often (in my experience), but if so, code for each.
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Old 12-14-2012, 08:45 AM
smwaters smwaters is offline
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Question Pricing, RVU, etc.

Does anyone have words of wisdom or references on pricing the new Cerebral Angio codes?? I'm at a loss since the new codes combine previously seperated codes that were used based on how many vessels were accessed.
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Old 12-20-2012, 10:01 AM
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denisemunsey denisemunsey is offline
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has any one been able to find crosswalk for the new codes
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Old 12-21-2012, 07:48 AM
Giancarlo Giancarlo is offline
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I attended a webinar through Dr Z if you want I can fax you the cross walk codes.
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Old 12-24-2012, 10:04 AM
montgomeryj2 montgomeryj2 is offline
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Default 2013 neuroendovascular codes

Giancarlo,
I would appreciate your faxing me the 2013 crosswalk or example scenarios
to 412-864-1528

Many thanks. Merry Xmas Happy New Year
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Old 12-27-2012, 07:00 AM
jenncash jenncash is offline
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Default Cross Walk

Could I please get a copy of the Cross walk also? Please fax to 502-588-9012
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