Part B Insider (Multispecialty) Coding Alert

Published on Fri Oct 01, 2004 PDF

You'll have more options for PET tumor imaging claims

If you've been feeling your OATS, then you'll welcome three new codes in 2005.

Procedures such as OATS and Mosaicplasty harvest osteochondral cores from a non-weight-bearing region of the femur and implant them into chondral defects in a patient's knee. Until now, the only code for these procedures was Category III code 0012T, which was sometimes difficult to obtain payment for, according to coder Maureen Pulcini with Pamlico Orthopedics in Washington, NC. Generally, she would send a letter along with the 0012T claim explaining the procedure, and hope to obtain payment. This approach usually worked well, she reports.

But now CPT 2005 will contain new codes for osteochondral autograft (29866) and allograft (29867) when performed via arthroscopy, as well as a code for open osteochondral allograft (27415). The new surgery codes also include codes for implantation of an autologous chondrocyte in the knee (27412) and meniscal transplantation via arthroscopy, including arthrotomy for meniscal insertion (29868).

Meanwhile, coders will have six new codes for tumor imaging, three for positron emission tomography scans and three for PET scans with concurrently acquired computed tomography. The first PET code (78811) and the first PET/CT code (78814) cover a limited area such as the chest or head/neck. The second PET (78812) and PET/CT (78815) codes cover from skull base to mid-thigh, and the third PET (78813) and PET/CT (78816) codes cover the whole body.

Two other new codes cover bone density studies and ophthalmic ultrasounds: 76077 (Dual energy x-ray absorptiometry [DXA], bone density study, one or more sites; vertebral fracture assessment) joins existing DXA codes 76075-76076, which cover the axial skeleton and appendicular skeleton respectively. And 76510 (Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter) joins existing ophthalmic ultrasound codes 76511-76513.

The new CPT codes also include three new codes for radiopharmaceutical therapy by oral administration (79005), intravenous administration (79101) and intra-arterial particulate administration (79445). Medicare doesn't cover oral administration of medications, because it considers these medications self-administered.