2011 CPT CODE CHANGES

The CPT coding changes for 2011 have been released. Understanding the new codes is crucial to obtaining the proper reimbursement. CPT 2011 underwent several changes, including a major change to CT abdomen and pelvis, and many changes in pain management and interventional procedures. All of the CPT changes are effective with January 1, 2011 dates of service. Below are highlights of the changes that will most commonly affect radiology practices. Click here for a complete list of all changes.

CT

Three new codes have been created for CT of the abdomen and pelvis when performed together. The existing CT abdomen and CT pelvis codes are still applicable when only one of the two studies are performed. CMS has not yet released the reimbursement for this combined CPT code, but you can count on a reimbursement reduction.

o 74176 Computed tomography, abdomen and pelvis; without contrast material
o 74177 Computed tomography, abdomen and pelvis; with contrast material(s)
o 74178 Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions

Ultrasound

The existing code for extremity US has been deleted and replaced by two new codes, one for a complete study and one for a limited.

o 76881 Ultrasound, extremity, nonvascular, real-time with image documentation; complete
o 76882 Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific

Non-Vascular Interventional Radiology

Spinal Procedures
In general, most of the procedure codes now include imaging guidance. Also, several new Category III T codes have been introduced in the spinal area. Category III codes are a set of temporary codes that represent new and emerging technology, and allow for data collection of these services.

Transforaminal steroid injections now include CT or fluoroscopic guidance in the procedure code and imaging would not be coded separately.

o 64479 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level
o 64480 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level (List separately in addition to code for primary procedure)
o 64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level
o 64484 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure)
o 0228T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level
o 0229T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; each additional level (List separately in addition to code for primary procedure)
o 0230T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level
o 0231T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; each additional level (List separately in addition to code for primary procedure)

Paravertebral Facet Joint Nerve Blockcodes saw similar changes in 2010 with the procedure codes, including CT and fluoroscopic guidance. CPT 2011 introduced new Category III T codes for paravertebral facet joint nerve blocks performed under ultrasound guidance.

o 0213T Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level
o 0214T Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; second level (List separately in addition to code for primary procedure)
o 0215T Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure)
o 0216T Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level
o 0217T Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; second level (List separately in addition to code for primary procedure)
o 0218T Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)

Peritoneal Procedures
The cholecystostomy code now includes all imaging guidance and new codes have been created for tunneled intraperitoneal catheter placement and removal, which also includes all associated imaging. The code for temporary intraperitoneal catheter placement has been deleted.

o 47490 Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation
o 49418 Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous
o 49419 Insertion of tunneled intraperitoneal catheter, with subcutaneous port (ie, totally implantable)
o 49421 Insertion of tunneled intraperitoneal catheter for dialysis, open
o 49422 Removal of tunneled intraperitoneal catheter

Vascular Interventional Radiology

Therapeutic Vascular Interventional Procedures
In the past, when multiple interventions were performed on the same lower extremity vessel, certain coding rules allowed for separate coding. The new codes are designed to be inclusive of associated interventions.

Many of the codes for peripheral transluminal angioplasty have been deleted or revised and replaced with new, more inclusive codes. Renal/visceral and brachiocephalic/upper extremity arteries are the exception. Based on the new codes, the only time angioplasty would be coded is if it is the ONLY intervention performed within a vessel. It has not yet been clearly documented, but it is assumed based on the CPT code changes that these codes include all imaging guidance required to perform the intervention.

o 37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty
o 37222 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
o 37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty
o 37228 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty
o 37232 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)

Existing stent placement codes have been revised and will no longer be used for lower extremity interventions. New codes for the stent placement in these arteries have been added in 2011. The new stent codes include angioplasty if also performed. It has not yet been clearly documented, but it is assumed based on the CPT code changes that these codes include all imaging guidance required to perform the intervention.

o 37221 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
o 37223 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
o 37226 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
o 37230 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
o 37234 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)

Existing atherectomy codes have deleted and replaced with new more inclusive codes for lower extremity atherectomy. There are also new codes that include atherectomy and stent placement in the lower extremities when performed together. New Category III codes have also been introduced for atherectomy of visceral, brachiocephalic, and iliac arteries and the abdominal aorta. Category III codes are a set of temporary codes that represent new and emerging technology and allow for data collection of these services. All of the atherectomy codes include angioplasty within the same vessel if performed. Again, it has not yet been clearly documented, but it is assumed based on the CPT code changes that these codes include all imaging guidance required to perform the intervention.

o 37225 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed
o 37227 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
o 37229 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
o 37231 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
o 37233 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
o 37235 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
o 0234T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; renal artery
o 0235T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; visceral artery (except renal), each vessel
o 0236T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; abdominal aorta
o 0237T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; brachiocephalic trunk and branches, each vessel
o 0238T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; iliac artery, each vessel

There have also been a few changes to the CPT codes for endovascular repair (for aneurysm, pseudoaneurysm, AVM, or trauma), specifically to repair of the iliac arteries. The existing code for iliac endovascular repair has removed the term “graft placement” and further clarified the repair to be using an ilio-iliac tube endograft prosthesis. Also, new Category III T codes have been introduced for repair of the iliac artery bifurcation.

o 34900 Endovascular repair of iliac artery (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using ilio-iliac tube endoprosthesis
o 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;
o 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

ADVOCATE will continue to provide up-to-date information on this topic and others as they arise.

With best regards,
Kirk Reinitz, CPA
President/CEO