Radiology:

CPT 2018 Anticipated Code Changes

A number of new codes and guideline revisions will be implemented for 2018.  As in past years, many of the new codes have been created as a result of bundling mandates from the AMA’s Relativity Assessment Workgroup (RAW) for the purpose of identifying potentially misvalued services.  Code pairs identified as being performed together 75 percent or more of the time and, therefore, referred to the CPT Editorial Panel for bundling in 2018 include such procedures as endovascular repair of infrarenal aorta and endovenous ablation of incompetent veins.

A new code also will be introduced to describe a combined bone marrow biopsy and aspiration study. In addition, Category III codes for cryoablation treatment of pulmonary tumors and transperineal placement of biodegradable material will be converted to Category I code status.

Chest X-ray Codes 

Chest x-ray codes 71010, 71015, 71020, 71021, 71022, 71023, 71030, 71034, and 71035 will be deleted and four new codes created to report chest x-ray procedures described by the number of views vs view-specific descriptors. 

Abdominal X-ray Codes

Abdominal x-ray codes 74000, 74010 and 74020 will be deleted and three new codes added to report abdominal x-ray procedures described by the number of views vs view-specific descriptors. 

Interventional Radiology

Cryoablation Treatment of Pulmonary Tumors

Look for a new CPT Category I code to replace Category III code 0340T, Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance, as well as revision to code 32998, Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s)… to include imaging for ablation of tumor.

Endovascular Repair Infrarenal Aorta

The RAW identified codes 34802, 34812, 34825 used to report endovascular repair of abdominal aortic aneurysms (EVAR), and some EVAR codes that may be billed frequently with other codes, for revision.  Look for a number of new bundled codes and revision to existing EVAR codes to demonstrate the most common application and the addition of codes to represent adjunctive procedures that may be performed with EVAR.

With the establishment of new codes, codes 34800-34806, 34825, 34826, 34900, 75952-75954, 93982, 0255T are proposed for deletion and code 0254T is to be revised.

Endovenous Ablation of Incompetent Veins

New codes will be established for the reporting of endovenous ablation therapy of incompetent veins using a chemical adhesive.  Revision of injection codes 36468, 36470, and 36471 will be made to distinguish treatment of spider veins and incompetent veins for telangiectasia and for diagnoses other than telangiectasia.

In addition, look for new codes to be created for reporting the injection of a non-compounded foam sclerosant for treatment of incompetent veins.

Bone Marrow Diagnostic Procedures

A new code will be created to describe a diagnostic bone marrow procedure that bundles biopsy and aspiration into one code. Currently, there are Correct Coding Initiative edits that do not allow the reporting of both procedures.  In addition, codes 38220, Bone marrow; aspiration only and 38221, Bone marrow; biopsy, needle or trocar will be revised to specify that these are diagnostic studies.

Brachial Retrograde Artery Introduction of Needle or Catheter

Look for angiography codes 36120 and 75658 to be deleted as these services are more appropriately reported with other existing upper extremity angiography codes.  With the deletion of code 36120, code 36140, Introduction of Needle or catheter, brachial retrograde artery, will be revised to describe upper or lower extremity and will become a stand-alone code.

Radiation Oncology

Transperineal Placement of Biodegradable Material

Look for a new CPT Category I code with revised descriptor to replace Category III code 0438T, Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance.

Code 77422 Marked for Deletion

Code 77422, High energy neutron radiation treatment delivery; single treatment area using a single port or parallel-opposed ports with no blocks or simple blocking, will be deleted due to low utilization. 

The high energy neutron radiation treatment delivery code77423 will be retained and not deleted as had been suggested.

Nuclear Medicine 

Code 78190, Kinetics, study of platelet survival, with or without differential organ/tissue localization, will be deleted due to low utilization.

Category III Codes

To Be Deleted:

0255T  Endovascular repair of iliac artery bifurcation (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using bifurcated endoprosthesis from the common iliac artery into both the external and internal iliac artery, unilateral; radiological supervision and interpretation

Coders will be referred to code 0254T

To Be Converted to Category I Code Status:

0340T  Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance

0438T  Look for a new CPT Category I code with revised descriptor to replace Category III code 0438T, Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance.

To Be Revised:

0254T  Endovascular repair of iliac artery bifurcation (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using bifurcated endoprosthesis from the common iliac artery into both the external and internal iliac artery, unilateral will be revised to bundle in all radiological supervision and interpretation.

To Be Extended:

042T  Cerebral perfusion analysis using computed tomography with contrast administration, including post-processing of parametric maps with determination of cerebral blood flow, cerebral blood volume, and mean transit time.