Radiology Coding Alert

The American Medical Associations CPT 2000, released last month, contains several important changes that will affect the radiology coder.

Radiation oncology is probably the area impacted most significantly, according to Linda Lively, MHA, president and CEO of American Medical Accounting and Consulting in Marietta, GA. The sheer number of changes in radiation oncology is not that great, she says, but they will have a tremendous impact on how we assign codes to our most common activities.

Specifically, the CPT 2000 has replaced four codes previously assigned for weekly management of radiation therapy with a single code. The new code is CPT 77427 (radiation treatment management, five treatments), Lively says. It replaces 77419 (weekly radiation therapy management; conformal), 77420 (simple), 77425 (intermediate) and 77430 (complex).

The benefit of this change, she says, is that it will simplify the billing processcoding professionals have only one choice. But the downside is that most radiation oncologists will experience a reduction in reimbursement.

The new RVU (relative value unit) for the 77427 code is 3.31, which is higher than the RVU for simple radiation treatment management in the past. However, it is lower than the previous RVU for complex management, which was in the 3.5 or 3.6 range. And I would estimate that 80 to 90 percent of a radiation oncologists work would be considered complex. Im sure the AMA figured that it would all even out, but Im not convinced that will be the case.

Lively expects that this replacement code may cause some confusion early next year, as well. Medicare will begin using 77427 as of Jan. 1, 2000, she points out, but other insurers will be scrambling to make the change. In the interim, radiology coders will need to use the new code for some payers and the old codes for others.

Another important new radiation oncology code is 76873 (prostate volume study for brachytherapy treatment planning), used for seed implantation in prostate cancer patients. In the past a variety of codes were used, says Lively, whose firm has specialized in coding, training and auditing for radiation oncology practices for more than 16 years. Some were urology codes and others were radiology codes. The new code will clarify things a great deal, since the language clearly describes prostate disease and brachytherapy. Its an important change because this treatment is very popular right now.

Lively also noted that the addition of two CPT Codes describing proton beam treatment delivery is significant. Not many radiation oncologists provide this treatment alternative because the equipment is large and expensive. Nevertheless, in the past these physicians had to assign 77499 (unlisted procedure, therapeutic radiology, clinical treatment management), which wasnt very desirable. This change will help a great deal.

The new proton beam treatment delivery codes are CPT 77520 (proton beam delivery to a single treatment area, single port, custom block, with or without compensation, with treatment set-up and verification images) and 77523 (proton beam delivery to one or two treatment areas, two or more ports, two or more custom blocks, and two or more compensators, with treatment set-up and verification images.)

Index of Additional Radiological Code Changes

Other codes that have been revised, added or deleted from the radiology section of CPT 2000 include:

q New Codes (relevant revised text in parenthesis)

72275Epidurography, radiological supervision and interpretation (For injection procedure, see 62280-62282, 62310-62319, 64479-64484)

73542Radiological examination, sacroiliac joint arthrography, radiological supervision and interpretation (For procedure, use 27096. If formal arthrography is not performed, recorded, and a formal radiologic report is not issued, use 76005 for fluoroscopic guidance for sacroiliac joint injections)

76005Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint), including neurolytic agent destruction

(Injection of contrast during fluoroscopic guidance and localization is an inclusive component of codes 62270-62273, 62280-62282, 62310-62319.)

(Fluoroscopic guidance for subarachnoid puncture for diagnostic radiographic myelography is included in supervision and interpretation codes 72240, 72255, 72265, 72270)

(For epidural or subarachnoid needle or catheter placement and injection, see codes 62270-62273, 62280-62282, 62310-62319)

(For sacroiliac joint arthrography, see 27096, 73542. If formal arthrography is not performed, recorded and a formal radiographic report is not issued, use 76005 for fluoroscopic guidance for sacroiliac joint injections)

(For paravertebral facet joint injection, see 64470-64476. For transforaminal epidural needle placement and injection, see 64479-64484)

(For destruction by neurolytic agent, see 64600-64680)

78267Urea breath test, C-14; acquisition for analysis

78268Analysis

78456Acute venous thrombosis imaging, peptide

q Revised Codes (revision in italics)

72285Diskography, cervical or thoracic, radiological supervision and interpretation

76513Anterior segment ultrasound, immersion (water bath) B-scan, or high resolution biomicroscopy (76515 has been deleted. To report, use 76999)

77499Unlisted procedure, therapeutic radiology treatment management (Editors Note: previously code read: Unlisted procedure, therapeutic radiology clinical treatment management.)

78457Venous thrombosis imaging, venogram; unilateral (Editors Note: previously code read: Venous thrombosis imaging (e.g., venogram); unilateral.)