Radiology Coding Guidelines and Best Practices

Updated Radiology Coding Guidelines For 2020

Seeking reimbursement for radiology services can be complicated with both private and public payers critically scrutinizing both diagnostic and interventional imaging services. Often, individual payers have their own specific rules that take priority when being billed, further complicating an already challenging claims process.

The American Medical Association’s (AMA) CPT code manual is revised annually to reflect new and updated technologies, changes related to bundling mandates, and guideline revisions. Once the changes were approved, the Centers for Medicare and Medicaid Services (CMS) publishes their Medicare Physician Fee Schedule each year outlining unit values and setting fee expectations that dictate reimbursement throughout the healthcare industry.

Comprehensive Coding for Radiological Services

Radiology is a medical specialty that uses techniques such as X-ray, Computed Tomography (CT), CT Angiography (CTA), Magnetic Resonance Imaging (MRI), MR Angiography (MRA), Ultrasound, Nuclear Medicine, and Positron Emission Tomography (PET) scans to diagnose as well as treat diseases or health conditions.

Often, individual payers have their own specific rules that take priority when being billed, further complicating an already challenging claims process. In this blog, we examine the difficulties in radiology coding and provide radiology billing and coding solutions to help you keep abreast of changes in the field.

CPT Coding Changes for 2020

According to the American College of Radiology (ACR), several radiology coding revisions are in place for 2020. These include changes to upper GI imaging, a new family of codes for nuclear medicine, and codes relating to myocardial and vascular imaging.

In addition, there were changes put into place in March 2020, as part of the expansion of telehealth services for E/M codes that can be found here.

Gastrointestinal Imaging

  • 74221 : Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; esophagus double-contrast study
  • 74248 : Radiologic small intestine follow-through study, including multiple serial images (Add-On)

Nuclear Medicine

  • 78830 : Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed, tomographic (SPECT) with 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
  • 78831 : Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed, tomographic (SPECT), minimum 2 areas (e.g., pelvis and knees, abdomen and pelvis), single-day imaging, or single area imaging over 2 or more days
  • 78832 : Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed, tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/ detection of pathology, minimum 2 areas (eg, pelvis and knees, abdomen and pelvis), single-day imaging, or single area imaging over 2 or more days
  • 78835 : Radiopharmaceutical quantification measurement(s) single area (Add-on)

PET Scans for Myocardial Imaging

  • 78429 : Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study, concurrently acquired computed tomography transmission scan
  • 78430 : Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/ or ejection fraction[s], when performed) single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan
  • 78431 : Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/ or ejection fraction[s], when performed) multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan
  • 78432 : Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (e.g., myocardial viability
  • 78433 : Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (e.g., myocardial viability); with concurrently acquired computed tomography transmission scan
  • 78434 : Absolute quantitation of myocardial blood flow (AQMBF), positron emission tomography (PET), rest and pharmacologic stress (Add-On)

Vascular Imaging

Two new codes have replaced HCPCS Level II code G0365 for Duplex scans for pre-operative vessel assessment for the creation of hemodialysis access.

  • 93985 : Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to the creation of hemodialysis access complete bilateral study
  • 93986 : Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to the creation of hemodialysis access complete unilateral study

CT Scanning – Bone Strength

There are new Category III codes for bone strength analysis.

  • 0554T : Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; retrieval and transmission of the scan data, assessment of bone strength and fracture risk and bone mineral density, interpretation and report
  • 0555T : Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; retrieval and transmission of the scan data
  • 0556T : Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; assessment of bone strength and fracture risk and bone mineral density
  • 0557T : Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; interpretation and report
  • 0581T : Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral

Vascular Interventional

These new codes replace Category III code 0254T.

  • 34717 : Endovascular repair of the iliac artery by deployment of an iliac branched endograft, including all RS&I, unilateral (add-on)
  • 34718 : Endovascular repair of iliac artery not associated with EVAR at the same session, including all RS&I, unilateral

And one new Category III code was introduced for transcatheter placement of iliac arteriovenous implant anastomosis.

  • 0553T : Percutaneous transcatheter placement of iliac arteriovenous anastomosis implant, inclusive of all radiological supervision and interpretation, intraprocedural road mapping, and imaging guidance necessary to complete the intervention

Spinal Procedures/Pain Management

  • 62328 : Spinal puncture, lumbar diagnostic, with fluoro or CT guidance
  • 62329 : Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter), w/fluoro or CT guidance

New codes were introduced for nerve injections, specifically sacroiliac and genicular nerves, including radiologic guidance.

  • 64451 : Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with fluoro or CT
  • 64454 : Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, with fluoro or CT
  • 64624 : Destruction by neurolytic agent, genicular nerve branches incl imaging guidance when performed
  • 64625 : Radiofrequency ablation, nerves innervating the sacroiliac joint, including imaging guidance when performed

ICD-10-CM Coding Changes for 2020

Deleted codes for 2020 include the following categories:

  • Vertigo
  • Atrial fibrillation
  • Congenital conditions
  • Ehlers-Danlos syndrome
  • ADA deficiency
  • Heatstroke or sunstroke

Coding additions include:

Genitourinary System

  • N63.15 : Right breast
  • N63.25 : Left breast
  • N99.85 : Post endometrial ablation syndrome

Phlebitis and Thrombophlebitis

  • 180.241 : Right peroneal vein
  • 180.242 : Left peroneal vein
  • 180.243 : Peroneal vein, bilateral
  • 180.249 : Unspecified peroneal vein
  • 180.251 : Right calf muscular vein
  • 180.252 : Left calf muscular vein
  • 180.253 : Calf muscular vein, bilateral
  • 180.259 : Unspecified calf muscular vein

Acute Embolism and Thrombosis

  • 182.451 : Right peroneal vein
  • 182.452 : Left peroneal vein
  • 182.453 : Peroneal vein, bilateral
  • 182.459 : Unspecified peroneal vein
  • 182.461 : Right calf muscular vein
  • 182.462 : Left calf muscular vein
  • 182.463 : Calf muscular vein, bilateral
  • 182.469 : Unspecified calf muscular vein

Fracture of the Orbital

  • S02.85XA : Initial encounter for closed fracture
  • S02.85XB : Initial encounter for open fracture
  • S02.85XD : Subsequent encounter for routine healing
  • S02.85XG : Subsequent encounter for fracture with delayed healing
  • S02.85XK : Subsequent encounter for fracture with nonunion
  • S02.85XS : Sequela
  • S02.849S : Fracture of lateral orbital wall, unspecified side, sequela

Creating a Complete Radiology Report

The golden rule of medical coding is that “if something is not documented then it was not done”. Therefore, the ACR practice guidelines state that a complete radiology report is mandatory to support proper code assignment and optimal reimbursement. The following elements, at the very least, are required in the radiology report:

  • Patient name
  • Referring physician name
  • Date, time, and location of study
  • Patient history
  • Reason for the study
  • Date and time of dictation and transcription
  • Radiologist’s signature

According to the ACR practice guideline, the radiology report “should address or answer any specific clinical questions. If there are factors that prevent answering of the clinical question, this should be stated explicitly”.

Radiology Billing and Coding Solutions

The intricacies and nuances of coding can make or break the success of your revenue capture. Using correct coding practices has the power to reduce denials and exponentially increase successful claims. Accurate coding means accurate charges for every patient’s treatment, consultation, and medication.

On the other hand, sluggish, inaccurate coding can back up revenue in a traffic jam of denials that often never get resolved. Key patient access and RCM areas for focus include:

  • Thorough insurance verification and pre-collections on amounts estimated to be due from the patient
  • Using proper CPT coding and documentation following a patient encounter and staying abreast of changes to guidelines and bundling requirements
  • Prior authorization with the ability to address same-day and emergent patient needs through the Authorization Determination Agent, a feature of the Infinx Prior Authorization Software, prior authorizations are identified and determined in real-time, saving valuable time when scheduling important procedures
  • Precise ICD-10 coding and billing procedures
  • Timely follow up and denial management
  • Insurance discovery to identify undisclosed patient coverage through insurance clearinghouses

You can prevent these costly mistakes by knowing all coding updates as well as the specific challenges faced in your practice or hospital. Having a complete radiology report can help ensure you and your team are using the right codes. Coding precision and accuracy results in maximum revenue for any healthcare organization.

Radiology is ground zero in the efforts to reduce health care usage. Whether utilizing an internal billing and coding department or engaging a third-party partner, a proactive approach to the healthcare payment lifecycle sets the stage for successful revenue cycle management.

Contact us today to put our radiology billing and coding solutions to work for you.

About the Author

Infinx
Infinx Healthcare provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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