The 2004 calendar year has brought many coding changes for interventional radiology procedures and with these changes come new reimbursement challenges. Updating charge tickets and system changes has been challenging enough, but the creation of new bundling edits has added to the confusion and frustration ofthese new codes. The biggest change by far has been in the central venous catheter procedure codes.
The new procedure codes for central venous devices can be categorized as:
- Insertion: placement of catheter through a newly established venous access
- Repair: fixing device without replacement of either catheter or port/pump, other than pharmacologic or mechanical correction of intracatheter or pericatheter occlusion
- Partial replacement of only the catheter component associated with a port/pump device, but not entire device
- Complete replacement of entire device via same venous access site (complete exchange)
- Removal of entire device
For these new codes, there is no coding distinction between venous access achieved percutaneously versus cutdown or based on catheter size. For all services except repositioning under fluoroscopy, the appropriate CPT code describing the service may now be assigned with a frequency of two when appropriate. If an existing central venous access device is removed and a new one placed via a separate venous access site, codes for both procedures (removal of old, if code exists, and insertion of new device) may be assigned. Also, the age criterion for these procedures has been changed from 2 to 5 years.
The table below provides a quick summary of the codes related to central venous access devices.
|Table. Summary of the codes related to central venous access devices. Courtesy of Coding Strategies Inc.|
In addition to new catheter procedure codes, two new imaging guidance codes were created in 2004 specifically for central venous catheter/device procedures.
- 75998 Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access sites or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)
- 76937 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent real-time ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)
It is important to note that the definition of 76937 requires “permanent recording.” Many of the handheld ultrasound devices are not capable of capturing a permanent image, which poses an operational and coding challenge. How can the use of ultrasound be billed when no permanent record is performed? The answer is, unfortunately, not at all. The creation of these new imaging codes has negated the ability to bill for the previously utilized ultrasound-guided needle localization code 76942.
An additional challenge to ensuring correct coding of the central venous catheter codes is understanding and abiding by the Correct Coding Initiative (CCI) bundling edits. CCI version 10.0, effective January 1, 2004, contained many edits related to these new codes. The following coding edits are a sample of the changes that should be reviewed to ensure accurate code submission:
- Chest x-rays are bundled into the central venous catheter fluoroscopic guidance code 75998.
- Fluoroscopy codes 76000-76003 are bundled into all of the central venous catheter codes except the repositioning code 36597.
- The fluoroscopy code 75998 is designated as mutually exclusive of the ultrasound guidance code 76937.
As a result of these CCI edits, either the fluoroscopy or the ultrasound guidance may be billed for a procedure (not both). Documentation is the key element indicator when determining which procedure code should be assigned. It is anticipated that the mutually exclusive edit bundling the two imaging guidance codes will be removed with CCI Version 10.1; however, it is important that the new edits be reviewed prior to modifying coding practices.
OTHER CODING ISSUES
The following coding updates for 2004 also are of interest to radiology practices:
- CPT code 43752 was rewritten to read “Naso- or oro-gastric tube placement, requiring physician’s skill and fluoroscopic guidance” (includes fluoroscopy, image documentation, and report)
- The code definition for the complete myelography code, 72270, was revised to clarify that this code should be assigned for “two or more regions.”
- The imaging codes for radiofrequency ablation were revised to indicate that their assignment is applicable only for visceral tissue ablation (eg, liver). The existing ultrasound guidance code, 76490, was deleted and replaced with 76940 for more appropriate placement in the CPT book. A new bone tumor ablation code, 20982, that was created includes both the ablation and the CT imaging guidance by definition.
- The Category III CPT code 0002T for the aorto-uni-iliac or aorto-unifemoral prosthesis was replaced with 34805.
Because the field of radiology is a dynamic specialty, radiology professionals must continue to reinforce their coding knowledge and stay abreast of the latest coding regulations to ensure both compliance with regulatory guidelines and the receipt of appropriate reimbursement.
Melody W. Mulaik, MSHS, CPC, RCC, is president, Coding Strategies Inc, Powder Springs, Ga.