Radiology Code Update for 2020

Radiology Code Update for 2020

Quite a few code changes and revisions were made to the Radiology section of CPT® for 2020. Less confusing language and expanded code categories will make life easier for medical coders. Here’s a quick review.

Gastrointestinal System

A mini overhaul of the gastrointestinal system codes removed the confusing language of “with or without KUB” and now specifies that a scout film is included when performed. The codes in this section are now based on whether single or double contrast was used. The previous small bowel follow-through codes are deleted and replaced with add-on code +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).

Gastrointestinal System Single Contrast Double Contrast
Esophagram 74220 74221
Upper GI 74240 74246
Small Intestine 74250 74251
Colon 74270 74280

Nuclear Medicine

As in previous years, the Nuclear Medicine section in CPT® required updates this year, as well. New and existing myocardial PET codes were revised to include ventricular wall motion and ejection fraction, when performed. Six new myocardial PET codes were added for metabolic evaluation, perfusion, or both, with options for both PET and PET/CT.

Myocardial Metabolic Evaluation Perfusion Both
PET – single 78459 78491 n/a
PET/CT – single 78429 78430 n/a
PET – multiple n/a 78492 78432
PET/CT – multiple n/a 78431 78433

Category I code 78434 Absolute quantitation of myocardial blood flow (AQMBF), positron emission tomography (PET), rest and pharmacologic stress (List separately in addition to code for primary procedure replaces deleted Category III code 0482T. This new code is for quantitation of myocardial blood flow at rest and stress, and is reported with codes 78492 and 78431.
Be sure to check out the revisions made to existing codes 78800, 78801, 78802, 78803, and 78804 for tumor localization by specifying them as planar, and the new codes for SPECT and SPECT/CT.
Many of the existing body specific codes were deleted in lieu of codes for single area or two or more areas done either in one day or over two or more days. Two notable exceptions to this change are imaging of the parathyroid and myocardial imaging.

Nuclear Medicine Planar SPECT SPECT/CT
Single area 78800 78803 78830
Multiple areas 78801 78831 78832
Whole body, single day 78802 n/a n/a
Whole body, 2 or > days 78804 n/a n/a

All of these codes include vascular and blood pool imaging, when performed. A new add-on code, +78835 Radiopharmaceutical quantification measurement(s) single area (List separately in addition to code for primary procedure), has been added for radiopharmaceutical quantification measurement(s), single area. You may report this code more than once only if the provider performs the service on more than one area.
Other changes outside of the 70000 series that may affect radiology include continued bundling of radiological guidance into primary procedures. For example, two new lumbar puncture codes, 62328 and 62329, bundle fluoroscopic and CT guidance. For those who work in vein clinics, be aware that the global surgical period for stab phlebectomies, 37765 and 37766, are reduced from 90 days to 10 days. The RVU value for these procedures is also reduced.
Duplex scan for arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access, formerly reported with HCPCS Level II code G0365, has been assigned two CPT® codes: 93985 Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study for complete bilateral study and 93986 Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete unilateral study for complete unilateral study. To be considered a “complete” study, the documentation must include both arterial inflow and venous outflow. These codes can be used for either upper or lower extremities and, unlike the G code, can be used for either initial or subsequent studies.
Radiology interacts with so many specialties that it is important to understand coding changes to order and/or preauthorize the correct codes.


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Lori M. Shore, CPC, RCC, RCCIR, FRBMA, has worked in radiology for 40 years and currently serves as Vice President of Coding Education and Compliance for MBMS, LLC where she has worked for over 33 years. Lori is a graduate of Drexel University in Philadelphia, PA where she holds a BS in Human Behavior and Development. She serves on a number of committees for both the Radiology Business Management Association (RBMA) as well as advisory boards for local community colleges.

9 Responses to “Radiology Code Update for 2020”

  1. Cristina says:

    What codes should I use now use to bill a Bonescan three phase spect ct? and do I use a modifier?

  2. Dentistry Longmont says:

    Great information! The change in technology regarding radiology and medication has made many things quite easy. Now a lot of good treatments are available for people. This change has also provided better solutions and whole body scanning for many serious issues. Keep sharing this more and more!
    Dentistry Longmont

  3. Laura Manser says:

    If 78830 SPECT single area (thoracic/lumbar spine) is performed, can 72128 also be billed along with this code? There are no CCI edits, but I’m not sure it is appropriate since 78830 includes concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis), single day imaging?

  4. Laura Manser says:

    If 78830 (thoracic/lumbar area) -Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), single area (eg, head, neck, chest, pelvis), single day imaging, is performed and they also dictate a separate report for CT scan of thoracic/lumbar spine performed at the same time, can this be billed together even though there are no CCI edits? It seems this would be included in the 78830 code?

  5. Stacy Chaplain says:

    From the author: Since this is not a PET/CT, you can bill for both the CT and the NM code since there are no CCI edits.

  6. Stacy Chaplain says:

    From the author: I would bill 78832 or you could use an unlisted procedure code. If you are billing for just the reading you would need to add modifier 26.

  7. Ana V. says:

    I am a little confused with codes 78432 and 78433 because the book does not specify as single or multiple, rest and/or stress study. It only states dual radiotracer. Can you verify why it’s considered a multiple study?

  8. mary brown says:

    Is A9521 now included in with nuclear medicine code 78800?

  9. Renee Dustman says:

    Mary Brown,

    From Lori Shore: A9521 is now considered an N1 code and is not separately reimbursed.