Coding Changes That Will Impact Radiology Practices in 2023

While only a few of the 225 new codes, 93 revised codes, and 75 deleted codes in Current Procedural Terminology (CPT)® for 2023 will impact radiology practices, it’s essential to know what they are and adjust your practice systems accordingly.

Diagnostic Radiology

Ultrasound

Code 76882 for a limited extremity study was revised to include “focal evaluation” of other nonvascular extremity structures, such as joint space, periarticular tendons, muscles, nerves, or other soft-tissue structures or masses.

A new code (76883) was added to describe “Ultrasound of nerves and accompanying structures throughout their entire anatomic course in one extremity.” 76883 is a com- prehensive code that includes real-time cine imaging, to be used once per extremity and not in conjunction with 76882.

According to the AAPC’s Radiology Coding Alert, it may be used for:

• Examination of multiple areas for potential nerve compression

• Measuring cross-sectional areas

• Assessment of echogenicity, vascularity, and mobility, which includes dynamic maneuvers (when indicated)

• Assessment for possible associated muscular denerva- tion, as well as comparison to unaffected muscles or nerves within that extremity (as needed)

Nuclear Medicine

Several codes related to tumor localization were modified to emphasize that they include “acquisition” in a single area, along with the rest of the procedural description.

The revised codes and descriptions are as follows:

See Table 1

Note that these descriptions and those below are paraphrased for readability, not verbatim from the CPT descriptions.

Interventional Radiology

Percutaneous Arteriovenous Fistula Creation

The American College of Radiology (ACR) reported that “two new codes will be available for percutaneous or endovascular approaches for creating arteriovenous anastomoses” in addition to the current codes to describe open surgical creation.

The new codes are as follows:

See Table 2

Somatic Nerve Injection

Coding for the injection of anesthetic agents for nerve

CPT Code Description

Radiopharmaceutical localization of tumor, inflammatory process, or distribution of radiopharmaceutical agents, including vascular flow and blood pool imaging, when performed.

78803 Using SPECT in a single area or acquisition in a single day of imaging. Single areas include, e.g., head, neck, chest, or pelvis.

78830 Using SPECT-CT for anatomical review, localization, and determination/detection of pathology in a single area or acquisition in a single day of imaging. Single areas include, e.g., head, neck, chest, or pelvis.

78831 Using SPECT in a minimum of 2 areas, or separate acquisitions in a single day of imaging, or a single area or acquisition over 2 or more days. Two areas include, e.g., pelvis and knees or chest and abdomen. Separate acquisitions include, e.g., lung ventilation and perfusion.

78832 Using SPECT-CT for anatomical review, localization, and determination/detection of pathology in a single area or acquisition in a minimum of 2 areas, or separate acquisitions in a single day of imaging, or a single area or acquisition over 2 or more days. Two areas include, e.g., pelvis and knees or chest and abdomen. Separate acquisitions include, e.g., lung ventilation and perfusion.

CPT Code Description

Percutaneous arteriovenous fistula creation, upper extremity, including all vascular access, imaging guidance and radiologic supervision and interpretation blocking now includes “imaging guidance, when performed.” With this bundling, separate billing of imaging guidance will no longer be permitted.

36836 Single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (e.g., transluminal balloon angioplasty, coil embolization) when performed.

36837 Separate access sites of both the peripheral artery and peripheral vein, including fistula maturation procedures (e.g., transluminal balloon angioplasty, coil embolization) when performed.

The codes affected are as follows:

See Table 3

Evaluation and Management

Interventional radiologists will use Evaluation and Management (E/M) codes more than diagnostic radiologists, as they often meet with patients at a separate time before a procedure. Healthcare Administrative Partner’s article, “Evaluation and Management Coding and Billing for Interventional Radiology,” provides a thorough review of the requirements for E/M billing. For 2023, many of the codes and some of the rules have changed. According to the AAPC, the changes render the CMS 1995 or 1997 Documentation Guidelines for E/M services outdated.

Consultation

The lowest level of consultation codes (99241 for office or outpatients, 99251 for inpatients) has been eliminated. The minimum requirement is now 20 minutes for an office or outpatient consultation (99242) or 35 minutes for an inpatient consultation (99252), in both cases involving straightforward medical decision making.

Note that Medicare does not accept consultation codes, so the regular visit codes would be used instead.

The table below describes office or outpatient visits:

See Table 4

Inpatients

The inpatient visit codes now include observation care services, and the coding is governed by either time or the level of medical decision making (MDM) in the same way as outpatient coding has been done since 2021. The codes for observation have been deleted.

The following table describes the thresholds of either time or the level of MDM required for the inpatient codes:

See Table 5

To qualify as an initial visit, the patient must not have received any professional services from a physician or other provider with the same subspecialty from the same group practice during the inpatient or observation stay. A nurse practitioner or physician assistant from the same group is considered to be in the same subspecialty as the physician, even though they do not have such a designation. A patient who is transitioned from observation to inpatient is considered to be in a single hospital stay.

Category III Codes

Category III codes are temporary codes that allow for data collection for emerging technologies, services, procedures, and service paradigms. They are not routinely covered by most payers, including Medicare, when they are initially issued, but that can change as they become more accepted and eventually transitioned into a Category I classification with regular reimbursement.

For 2023, two new codes X031T and X032T are available to report bone strength and fracture risk assessment using digital X-ray radiogrammetry-bone-mineral density.

Conclusion

It is important to keep abreast of all the code changes to optimize the success of your radiology practice.

Erin Stephens, CPC, CIRCC, Sr. Client Manager, Education Healthcare Administrative Partners

HAP is a revenue cycle management company for medical facilities with over two decades of experience serving physician practices in a variety of settings and medical specialties. Our story began in 1995 near Philadelphia where our headquarters is still located. Since then, our client-base has grown to encompass many renowned hospital-based practices and academic medical centers across the country.

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