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Interventional Views Blog

2019 Radiology and IR CPT Code Changes May Impact Your Radiology Practice Performance

Endovascular & Interventional Center Billing Performance Interventional Radiology Coding Endovascular Coding

There are new, revised, and deleted codes for 2019. The most influential code sets that could affect your practice are the PICC line placements (36568-36573) and the new FNA biopsy codes (10004-10021). The wRVUs may be lower, but that should not influence your documentation of guidance used with these procedures.


2019 CPT Changes
 

FINE NEEDLE ASPIRATION BIOPSY

There has been a major update to the fine needle aspiration codes.  Imaging is now bundled into the base procedure code. 

Deleted:

  • 10022 Fine needle aspiration biopsy with imaging guidance 

Revised:

  • 10021 Fine needle aspiration biopsy without imaging, first lesion  

New:

  • 10004 Fine needle aspiration biopsy, without imaging guidance; each additional lesion (List separately in addition to code for primary procedure)
  • 10005 Fine needle aspiration biopsy, including ultrasound guidance; first lesion
  • 10006 . . . each additional lesion (List separately in addition to code for primary procedure)
  • 10007 Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
  • 10008 . . . each additional lesion (List separately in addition to code for primary procedure)
  • 10009 Fine needle aspiration biopsy, including CT guidance; first lesion
  • 10010 . . . each additional lesion (List separately in addition to code for primary procedure)
  • 10011 Fine needle aspiration biopsy, including MR guidance; first lesion
  • 10012 . . . each additional lesion (List separately in addition to code for primary procedure) 

 

How does this affect you?

 

CPT

Description

2018 wRVUs

2018 CMS Allowed

 

CPT

Description

2019 wRVUs

2019 CMS Allowed

10022

FNA

1.26

$73.94

 

10005

FNA w/ US Guidance

1.46

$75.68

76942

US Guidance

0.67

$36.18

 

 

 

 

 

Total

 

1.94

$110.12

 

 

 

 

 

 

*Please continue to state the guidance used in order to code the proper procedure code.  If additional lesions  are biopsied, please indicate that as well. 

New requirement from the 2019 NCCI Manual: 

“Fine needle aspiration (FNA) biopsies (CPT codes 10004-10012, and 10021) shall not be reported with a biopsy procedure code for the same lesion. For example, an FNA specimen is usually examined for adequacy  when the specimen is aspirated. If the specimen is adequate for diagnosis, it is not necessary to obtain an additional biopsy specimen.  However, if the specimen is not adequate and another type of biopsy (ie. needle,  open) is subsequently performed at the same patient encounter, the physician shall report only one code, either the biopsy code or the FNA code. (CPT code 10022 was deleted January 1, 2019.)”

 

BREAST MRI 

Deleted:

  • 77058 Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral
  • 77059 Magnetic resonance imaging, breast, without and/or with contrast material(s);bilateral
  • 0159T CAD Breast MRI

New:

  • 77046 Magnetic resonance imaging, breast, without contrast material; unilateral
  • 77047 bilateral
  • 77048 Magnetic resonance imaging, breast, without and with contrast
  • material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral
  • 77049 bilateral

 

*Please continue to state in your documentation whether the study was performed without or with/without  contrast. Also, include if computer aided detection (CAD) was utilized.

 

KNEE ATHROGRAPHY

Deleted:

  • 27370 Injection procedure for contrast knee arthrography

New:

  • 27369 Injection procedure for contrast knee arthrography or CT/MRI knee arthrography

 

Rationale according to CPT Changes An Insider’s View:

The AMA RUC RAW screen identified code 27370 for high-volume growth, and a recommendation was made to revise this code to reflect current practice. It was determined that if such extensive revisions were  needed, a new code should be created and to delete 27370.  The previous code did not include contrast enhanced CT/MRI knee arthrography.  However, code 27369 can be reported for a knee injection for contrast arthrography or contrast enhanced CT/MRI knee arthrography.

 

PICC INSERTION AND REPLACEMENT

Revised:

  • 36568 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age
  • 36569 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older 

New:

  • 36572 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age
  • 36573 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; age 5 years or older
  • 36584 Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement

 

How does this affect you?                       

CPT

Description

2018 Total RVUs

2018 CMS Allowed

 

CPT

Description

2019 Total RVUs

2019 CMS Allowed

36569

PICC Insertion

1.70

$88.56

 

36573

PICC Insertion w/ Guidance

1.70

$96.46

76937

US Guidance

0.30

$14.76

 

36569

PICC Insertion w/o Guidance

1.90

$107.09

77001

Fluoro Guidance

0.38

$19.08

 

 

 

 

 

Total

 

2.38

$122.40

 

 

 

 

 


Per CPT: 

*"Midline" catheters by definition terminate in the peripheral venous system. They are not central venous  access devices and may not be reported as a PICC service. Midline catheter placement may be reported with 36400, 36405, 36406, or 36410.

 

Reminder* 

Ultrasound guidance requires:

  • Evaluation of potential access site(s) 
  • Selected vessel patency 
  • Concurrent real-time ultrasound visualization of needle entry  
  • Storage of permanent images (either film or digital) 

 

Fluoroscopic guidance requires: 

  • Use of fluoroscopy 
  • Contrast injections through the access site 
  • Images (saved) to confirm the final catheter position

 

G-TUBE REPLACEMENT

Deleted:

  • 43760 Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance 

New:

  • 43762 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract
  • 43763 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract

 

If you have any further questions, please contact

Kristen Bickel Sliwinski CCA, RCC at kbickel@streamlinemd.com