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 comprehensive code that includes real-time cine imaging, to be used once per extremity and not in conjunction with 76882. According to the AAPC Radiology Coding Alert, it may be used for the following:
- 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 denervation, as well as comparison to unaffected muscles or nerves within that extremity (as needed)
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:
|Radiopharmaceutical localization of tumor, inflammatory process, or distribution of radiopharmaceutical agents, including vascular flow and blood pool imaging, when performed.
||Using SPECT in a single area or acquisition in a single day of imaging. Single areas include, e.g., head, neck, chest, or pelvis.
||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.
||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.
||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.
Note that these descriptions and those below are paraphrased for readability, not verbatim from the CPT descriptions.
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:
|Percutaneous arteriovenous fistula creation, upper extremity, including all vascular access, imaging guidance, and radiologic supervision and interpretation
||single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (e.g., transluminal balloon angioplasty, coil embolization) when performed
||separate access sites of both the peripheral artery and peripheral vein, including fistula maturation procedures (e.g., transluminal balloon angioplasty, coil embolization) when performed
Somatic Nerve Injection
Coding for the injection of anesthetic agents for nerve blocking now includes "imaging guidance, when performed." With this bundling, separate billing of imaging guidance will no longer be permitted. The codes affected are as follows:
|Injection of anesthetic agent(s) and/or steroid, including imaging guidance, when performed
||Brachial plexus, continuous infusion by catheter (including catheter placement)
||Sciatic nerve, continuous infusion by catheter (including catheter placement)
||Femoral nerve, continuous infusion by catheter (including catheter placement)
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. Our 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.
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:
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:
||At least 40 minutes or straightforward/low MDM
||At least 25 minutes or straightforward/low MDM
||At least 55 minutes or moderate MDM
||At least 35 minutes or moderate MDM
||At least 75 minutes or high MDM
||At least 50 minutes or High MDM
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.
It is important to keep abreast of all the code changes to optimize the success of your radiology practice.
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.
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