Erin Stephens.
The annual update to the Current Procedural Terminology1 (CPT) for 2024 has 230 new codes, 70 revised codes, and 49 deleted codes. In addition, there are 395 new diagnosis codes contained in the ICD-10-CM2 update, about one-third of them describing new ways to capture accidents and injuries. Although relatively few of these changes will impact radiology practices, it’s essential to know what they are and adjust your practice systems accordingly.
Diagnostic radiology
Coronary Fractional Flow Reserve (FFR) with CT:
New Category I code 75580 will replace Category III codes 0501T, 0502T, 0503T, and 0504T to describe noninvasive estimated coronary FFR derived from augmentative AI software analysis of coronary CT angiography (CCTA) data. “Augmentative” means that a physician or other qualified healthcare professional is required to interpret and report on the analysis. When the interpretation occurs on the same day as the CCTA, then 75580 is used in conjunction with coding for the CCTA (75574).
Cardiac Intraoperative Ultrasound (IOUS) Services:
New codes are available to report cardiac IOUS, as follows:
| CPT Code | Description |
|---|---|
| 76984 | Ultrasound, intraoperative thoracic aorta (e.g., epiaortic), diagnostic |
| Intraoperative epicardial cardiac ultrasound (i.e., echocardiography) for congenital heart disease, diagnostic; | |
| 76987 | including placement and manipulation of transducer, image acquisition, interpretation, and report |
| 76988 | placement, manipulation of transducer, and image acquisition only. |
| 76989 | interpretation and report only |
Cardiac IOUS is used primarily during cardiothoracic surgery procedures to evaluate structures, provide intraoperative guidance, and real-time perioperative surgical decision-making information that may affect the operative strategy.
Vascular Ultrasound Guidance
Beginning January 1, 2024, Medicare will no longer pay separately for CPT code 76937 “Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites …” associated with any procedure that “includes radiological supervision and interpretation.”
Ultrasound guidance is now bundled with the primary procedure. The removal of separate billing for the ultrasound guidance code means a loss of $37.66 per procedure when billing globally, or $13.43 for the professional component, using the national Medicare reimbursement rates.
Several specialty societies have filed their objection to this rule change with CMS, and there is hope that it could possibly be reversed.
Interventional radiology
Dorsal Sacroiliac Joint Arthrodesis:
New Category I code 27278 will replace Category III code 0775T, and existing code 27279 has been modified. According to the American College of Radiology’s description of the new code changes, the new code 27278 “will allow the reporting of percutaneous intra-articular placement of one or more fusion implant(s) directly into the SI joint under imaging guidance.
This is typically performed from a posterior/dorsal approach.” Regarding code 27279, the ACR says that it is “used to report percutaneous placement of a transfixation device, such as a screw, across the SI joint to perform fusion. This is typically performed from a lateral approach.”
| CPT Code | Description |
|---|---|
| 27278 | Arthrodesis, sacroiliac joint, percutaneous, with image guidance, including placement of intra-articular implant(s), without placement of transfixation device. |
| 27279 | Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, with placement of transfixation device. |
Transcervical Radiofrequency Ablation (RFA) of Uterine Fibroids:
New Category I code 58580 will replace Category III code 0404T.
| CPT Code | Description |
|---|---|
| 58580 | Transcervical radiofrequency ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring. |
Coronary Intravascular Lithotripsy (IVL) Interventions:
New Category I code 92972 will replace Category III code 0715T to describe coronary IVL, a revascularization technique used to treat heavily calcified coronary arteries. This is an add-on code to be used in conjunction with the primary procedure codes such as those describing coronary transluminal angioplasty, atherectomy, or stent placement.
| CPT Code | Description |
|---|---|
| 92972 Add-on |
Percutaneous transluminal coronary lithotripsy |
Cystourethroscopy:
A new code has been added, as follows:
| CPT Code | Description |
|---|---|
| 52284 | Cystourethroscopy, with mechanical urethral dilation and urethral therapeutic drug delivery by drug-coated balloon catheter for urethral stricture or stenosis, male, including, including fluoroscopy when performed. |
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 reimbursed 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 2024 several new Category III codes will be available, as follows:
| CPT Code | Description |
|---|---|
| Quantitative MRI analysis of the brain with comparison to prior MRI studies, including lesion identification, characterization, and quantification, with brain volume(s) quantification and/or severity score, when performed, data preparation and transmission, interpretation and report; | |
| 0865T | Obtained without diagnostic MRI examination of the brain during the same session |
| 0866T Add-on |
Obtained with diagnostic MRI examination of the brain. List separately in addition to the code for the primary procedure. |
| CPT Code | Description |
|---|---|
| 0814T | Percutaneous injection of calcium-based biodegradable osteoconductive material, proximal femur, including imaging guidance, unilateral |
| 0815T | Ultrasound-based radiofrequency echographic multi-spectrometry (REMS), bone-density study and fracture-risk assessment, one or more sites, hips, pelvis, or spine. |
| 0857T Add-on |
Opto-acoustic imaging, breast, unilateral, including axilla when performed, real-time with image documentation, augmentative analysis and report. Use in conjunction with breast ultrasound codes 76641 or 76642. |
Diagnosis coding
The most relevant ICD-10-CM code changes for radiology involve the expansion of coding for breast density, including laterality. Breast density is categorized by the breast imaging-reporting and data system (BI-RADS). Here are the codes to be used for 2024:
| ICD Code | Description |
|---|---|
| R92.30 | Dense breasts, unspecified |
| Mammographic fatty tissue density | |
| R92.311 | Right breast |
| R92.312 | Left breast |
| R92.313 | Bilateral breasts |
| Mammographic fibroglandular density | |
| R92.321 | Right breast |
| R92.322 | Left breast |
| R92.323 | Bilateral breasts |
| Mammographic heterogeneous density | |
| R92.331 | Right breast |
| R92.332 | Left breast |
| R92.333 | Bilateral breasts |
| Mammographic extreme density | |
| R92.341 | Right breast |
| R92.342 | Left breast |
| R92.343 | Bilateral breasts |
Erin Stephens is senior client manager, education at Healthcare Administrative Partners.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
References
- Current Procedural Terminology is a copyrighted code set developed and maintained by the American Medical Association, and CPT is a registered trademark.
- ICD stands for International Classification of Diseases, the system owned and copyrighted by the World Health Organization that is used to report diagnoses when submitting claims for reimbursement of physician services, among many other purposes. ICD-10 is the 10th edition of this coding system. CM stands for the Clinical Modification of the classification system.
