Radiology Coding Guidelines and Best Practices

By Infinx
June 6, 2019

Updated Radiology Coding Guidelines For 2019

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 outlining unit values and setting fee expectations that dictate reimbursement throughout the healthcare industry.

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. Seeking reimbursement for these services can be very complicated as both private and public payors critically scrutinize imaging services. 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

According to the American College of Radiology (ACR), the major coding changes are in PICC Insertion and Replacement, Breast MRI, Fine Needle Aspiration Biopsies, Knee Athrography, and G-Tube Replacement.

PICC Line Insertion and Replacement Codes

The new and revised PICC Line Insertion and Replacement codes for 2019 are:

Revised:

  • 36568 – Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age
  • 36569 – Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older
  • 71047: 3 views chest
  • 71048: 4 or more views

New:

  • 36572 – Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age
  • 36573 – Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; age 5 years or older
  • 36584 – Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement

Breast MRI Codes

With the new Breast MRI Codes, it is imperative that you continue to document whether the study was performed with or without contrast and if CAD detection was used. New and deleted Codes for 2019 are as follows:

Deleted:

  • 77058 – Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral
  • 77059 – Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral
  • 0159T – CAD Breast MRI

New:

  • 77046 – Magnetic resonance imaging, breast, without contrast material; unilateral
  • 77047 – bilateral
  • 77048 – Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization, and pharmacokinetic analysis), when performed; unilateral
  • 77049 – bilateral

Fine Needle Aspiration Biopsy Codes

The imaging component of fine needle aspiration has now been bundled with the base procedure code. This is a major change and should be monitored closely.

Deleted:

  • 10022 – Fine needle aspiration biopsy with imaging guidance

Revised:

  • 10021 – Fine needle aspiration biopsy without imaging, first lesion

New:

  • 10004 – Fine needle aspiration biopsy, without imaging guidance; each additional lesion (List separately in addition to code for primary procedure)
  • 10005 – Fine needle aspiration biopsy, including ultrasound guidance; first lesion
  • 10006 . . . each additional lesion (List separately in addition to code for primary procedure)
  • 10007 – Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
  • 10008 . . . each additional lesion (List separately in addition to code for primary procedure)
  • 10009 – Fine needle aspiration biopsy, including CT guidance; first lesion
  • 10010 . . . each additional lesion (List separately in addition to code for primary procedure)
  • 10011 – Fine needle aspiration biopsy, including MR guidance; first lesion
  • 10012 . . . each additional lesion (List separately in addition to code for primary procedure)

Knee Athrography

The AMA concluded that there was the potential for high-volume growth in knee arthrography due to an aging population and revised the code to include CT/MRI knee arthrography.

Deleted:

  • 27370 – Injection procedure for contrast knee arthrography

New:

  • 27369 – Injection procedure for contrast knee arthrography or CT/MRI knee arthrography

Gastronomy Tube Replacement

And last, the deleted and new code for G-Tube replacement:

Deleted:

  • 43760 – Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance

New:

  • 43762 – Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract
  • 43763 – Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract

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 a must in the radiology report:

  • Patient name
  • Referring physician name
  • Date and time of study
  • Patient history
  • Reason for the study

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.” The guideline also recommends documenting the date of the report’s dictation and date and time of transcription, in addition to the radiologist’s signature.

Radiology Billing and Coding Solutions

The intricacies and nuances of coding can make or break the success of your claims.  Using correct coding practices has the power to reduce denials and exponentially increase successful claims. Accurate coding means accurate charges for every patient treatment, consultation, and medication. On the other hand, sluggish, inaccurate coding can back up revenue in a traffic jam of denials.  Key billing and coding 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
  • Precise ICD-10 coding and billing procedures
  • Timely follow up and denial management

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 using a third-party solution, a proactive approach to the healthcare payment lifecycle sets the stage for successful revenue management.

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

About the Author

Infinx

Infinx

Infinx 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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