2017 CPT Changes – ADVOCATE Annual Summary

The CPT coding changes for 2017 have been released. Understanding the new codes is crucial to obtaining the proper reimbursement for your services and ADVOCATE has analyzed the changes and provided the highlights below. ADVOCATE will provide more detail on the new codes in an upcoming webinar.

The major changes in CPT 2017 are once again in vascular interventional radiology and breast imaging codes.  All of the CPT changes are effective with January 1, 2017 dates of service. Below are highlights of the changes that will most commonly affect radiology practices.

BREAST IMAGING

As anticipated, new codes have been introduced this year for mammography.  These new codes bundle the CAD into the mammogram.

While the AMA has released these new codes, CMS communicated in the Final Rule that due to claims processing issues, CMS will not accept these new codes in 2017.  Instead, providers should utilize the existing G codes for mammography (see below).  These codes will reflect the new code descriptions inclusive of CAD.  CMS is expected to accept the new mammogram codes in 2018.  Other payers may follow CMS’s guidance on this, so providers should be aware of which code(s) will be accepted for specific payers.

77065 – Diagnostic mammo, including CAD, unilateral (G0206)

77066 – Diagnostic mammo, including CAD, bilateral (G0204)

77067 – Screening mammo, including CAD, bilateral (G0202)

Tomosynthesis should still be reported separately

AAA SCREENING ULTRASOUND

A new code was created for abdominal aortic aneurysm (AAA) screening.  This was previously reported with G0389.

76706 – US abdominal aorta, AAA screening

FLUOROSCOPIC GUIDANCE-REVISION

In 2017, fluoroscopic guidance codes 77002 and 77003 will be add-on codes and must be reported with the base procedure code.  What this means is that the provider billing for the guidance must be the same provider billing for the procedure code.

EPIDURAL INJECTIONS

The existing codes for epidural injections will be replaced with new codes in 2017.  The new codes are categorized for with or without imaging guidance.  Fluoroscopic guidance code 77003 should not be reported with any of these new codes.

62320 – Epidural injection, cervical/thoracic, without imaging guidance

62321 – Epidural injection, cervical/thoracic, with imaging guidance

62322 – Epidural injection, lumbar/sacral, without imaging guidance

62323 – Epidural injection, lumbar/sacral, with imaging guidance

62324 – Epidural injection, incl indwelling cath, cont infusion, or bolus cervical/thor, without imaging guidance

62325 – Epidural injection, incl indwelling cath, cont infusion, or bolus cervical/thor, without imaging guidance

62326 – Epidural injection, incl indwelling cath, cont infusion, or bolus cervical/thor, without imaging guidance

62327 – Epidural injection, incl indwelling cath, cont infusion, or bolus cervical/thor, without imaging guidance

VENOUS ABLATION

New codes were created in 2017 for mechanicochemical endovenous ablation therapy.  These were previously unlisted procedures.

36473 – Endovenous ablation therapy incompetent vein, mechanochemical, first vein

36474 – Endovenous ablation therapy incompetent vein, mechanochemical, each subseq vein, sep access

CRYOABLATION EXTREMITY NERVE

New Category III* codes were created in 2017 for cryoablation of upper/lower extremity nerves.  These were also previously unlisted procedures.

0440T – Cryoablation, upper extremity nerve

0441T – Cryoablation, lower extremity nerve

*-Category III codes are temporary codes created for emerging technology, services, and procedures.    Use of these Category III codes allows data collection for these services and procedures.

ANGIOPLASTY

As in prior years, new comprehensive codes were created for angioplasty.  These new codes replace existing arterial/venous angioplasty and are to be used wherever there is not currently a more specific angioplasty code.  These codes include all of the imaging and radiologic supervision and interpretation necessary to perform the angioplasty.  Catheter placements may be coded separately.

37246 – Angioplasty, arterial (non-lower extremity, coronary, pulmonary, or dialysis circuit), inc RS&I, initial

37247 – Angioplasty, arterial (non-lower extremity, coronary, pulmonary, or dialysis circuit), inc RS&I, each add’l

37248 – Angioplasty, venous, initial

37249 – Angioplasty, venous, each add’l

DIALYSIS CIRCUIT PROCEDURES

Hemodialysis fistula/graft procedures are once again seeing a major restructuring in 2017 and all existing codes will be deleted.  These codes are comprehensive, including the puncture(s) of the dialysis circuit and diagnostic angiography and all necessary imaging from the arterial anastomosis through the entire venous outflow including the inferior or superior vena cava.  These codes have a hierarchy similar to the lower extremity revascularization codes.

36901 – Dialysis fistulagram/shuntogram

36902 – Dialysis fistulagram/shuntogram, with angioplasty, peripheral

36903 – Dialysis fistulagram/shuntogram, with stent, peripheral (inc angioplasty)

36904 – Thrombectomy/thrombolysis dialysis circuit, any method

36905 – Thrombectomy/thrombolysis dialysis circuit, any method, with angioplasty, peripheral segment

36906 – Thrombectomy/thrombolysis dialysis circuit, any method, with stent, peripheral segment (inc angioplasty)

36907 – Angioplasty central dialysis segment, through dialysis circuit, add on

36908 – Stent central dialysis segment, through dialysis circuit (inc angioplasty), add on

36909 – Dialysis circuit embolization, add on

MODERATE SEDATION

Perhaps one of the biggest changes that can be expected in interventional radiology coding for 2017 pertains to moderate sedation.  Previously, moderate sedation was bundled into many procedure codes that were identified in the CPT book with a bullseye symbol.  In 2017, the bullseye and the existing moderate sedation codes have been deleted and replaced with a new set of codes that may be billed separately from the procedure.

99151 – Moderate sedation, same physician, first 15 minutes, less than 5 years old

99152 – Moderate sedation, same physician, first 15 minutes, age 5 or older

99153 – Moderate sedation, same physician each additional 15 minutes

99155 – Moderate sedation, different physician, first 15 minutes, less than 5 years old

99156 – Moderate sedation, different physician, first 15 minutes, age 5 or older

99157 – Moderate sedation, different physician each additional 15 minutes

More crucial than ever is the documentation for moderation sedation.  These codes are based on intraservice time, which must be clearly documented.  Intraservice time and work is defined as the continuous face to face presence of the physician or other qualified health care professional with the patient and requires monitoring of the patient’s response to the sedation agent.

As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.

Best regards,
Jennifer Bash, RHIA, CPC, CIRCC, RCC
Coding & Documentation Education Manager