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2018 CPT Code Update: Interventional & Diagnostic Radiology

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2018 CPT Code Update: Interventional & Diagnostic Radiology 11/30/2017 2018 CPT Code Update: Interventional & Diagnostic Radiology Stacie L. Buck, RHIA, CCS‐P, RCC, CIRCC, AAPC Fellow President & Senior Consultant RadRx December 5, 2017 RadRx “Your Prescription for Accurate Coding & Reimbursement” Speaker Stacie L. Buck, RHIA, CCS‐P, RCC, CIRCC • Stacie L. Buck, RHIA, CCS‐P, RCC, CIRCC, RCC is President & Senior Consultant at RadRx in Stuart, FL. Stacie is a nationally sought out speaker who provides consulting services to providers of diagnostic and interventional radiology services. She is the author of the book Cracking the IR Code: Your Comprehensive Guide to Mastering Interventional Radiology Coding and creator of Mastering Interventional Radiology & Cardiology Online Education Program. Stac ie has 25 years experience in healthcare, 17 of which she has spent working in radiology. She is a nationally Contact sought out speaker who has presented Email: [email protected] well over 200 coding seminars. Website: www.radrx.com RadRx “Your Prescription for Accurate Coding & Reimbursement” 2 1 11/30/2017 DIAGNOSTIC RADIOLOGY RadRx “Your Prescription for Accurate Coding & Reimbursement” Chest X‐Rays • 71045 Radiologic examination chest; single view – 71010 (frontal), 71015(stereo frontal), 71035 (special views) • 71046 Radiologic examination chest; two views – 71020 (AP & Lat), 71035 (special views) • 71047 Radiologic examination chest; three views – 71021 (2 v w/ apical lordotic), 71022 (2v w/ oblique), 71035 ((pspecial views) • 71048 Radiologic examination chest; 4 or more views – 71030 (min 4 v), 71034 (min 4 v w/ fluoro), 71035 (special views) RadRx “Your Prescription for Accurate Coding & Reimbursement” Copyright 2017. RadRx all rights reserved. Unauthorized distribution is prohibited. 2 11/30/2017 Abdominal X‐Rays • 74018 Radiologic examination abdomen; 1 view – 74000 (AP) • 74019 Radiologic examination abdomen; 2 views – 74010 (AP & addl oblique/cone) • 74021 Radiologic examination abdomen; 3 or more views – 74020 (complete inc. decubitus and/or erect) RadRx “Your Prescription for Accurate Coding & Reimbursement” Copyright 2017. RadRx all rights reserved. Unauthorized distribution is prohibited. Revised: 76881 & 76882 • 76881 Ultrasound, complete joint (ie, joint space and peri‐articular soft tissue structures) real‐time with image documentation – Old “extremity, nonvascular” • 76882 Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, joint space peri‐articular tendon[s], muscle[s], nerve[s], other soft tissue structure[s], or soft tissue mass[es]), real‐ time with image documentation – Old “extremity, nonvascular…limited, anatomic specific” RadRx “Your Prescription for Accurate Coding & Reimbursement” Copyright 2017. RadRx all rights reserved. Unauthorized distribution is prohibited. 3 11/30/2017 Revised: 76881 & 76882 • 76881 requires US exam of all of the following: – Joint space (eg, effusion) – Peri‐articular soft‐tissue structures that surround the joint (ie, muscles, tendons, other soft tissue structures), and any identifiable abnormality. – Includes dynamic imaging or stress maneuvers when performed – Permanently recorded images required with a written report containing a description of each of the element(s) or reason for non‐visualization RadRx “Your Prescription for Accurate Coding & Reimbursement” Copyright 2017. RadRx all rights reserved. Unauthorized distribution is prohibited. Revised: 76881 & 76882 • 76882 represents a limited exam of a joint or an evaluation of a structure(s) in an extremity other than a joint: – Soft tissue, fluid collection, or nerve(s) – Assessment of specific anatomic structure – Joint space only (effusion), tendon, muscle, and/or other soft tissue structure(s) that surround the joint – Permanently recorded images required with a written report containing a description of each of the element(s) RadRx “Your Prescription for Accurate Coding & Reimbursement” Copyright 2017. RadRx all rights reserved. Unauthorized distribution is prohibited. 4 11/30/2017 Appropriate Use Criteria (AUC) • Applies to “advanced” imaging: CT/MR/PET/Nuclear Medicine • Delayed until January 1, 2020 – Allow ordering physicians time to select a Clinical Decision Support Mechanism (CDSM) – Voluntary reporting currently allowed – MIPS Improvement Activity for 2018 (high weight activity) – 2020 will be a “testing” year not affecting payment of Medicare claims. • Ordering professionals will be required to consult AUC and furnishing providers will report AUC consultation information on the claim • Imaging facility and interpreting provider required to report: – Qualified CDSM consulted by the ordering physician – Whether the service ordered would adhere to specified applicable AUC – NPI of the ordering physician • Required for both the TC & PC claims for applicable advanced diagnostic imaging services in all three applicabl e payment systems (PFS, HOPPS and ASC). • Qualified CDSMs: https://www.cms.gov/Medicare/Quality‐Initiatives‐Patient‐ Assessment‐Instruments/Appropriate‐Use‐Criteria‐Program/CDSM.html RadRx “Your Prescription for Accurate Coding & Reimbursement” 9 Copyright 2017. RadRx all rights reserved. Unauthorized distribution is prohibited. Appropriate Use Criteria (AUC) • G codes will be created for CDSM – Line‐item on both practitioner and facility claims. – CMS would expect that one AUC consultation G‐code would be reported for every advanced diagnostic imaging service on the claim with a HCPCS modifier. • HCPCS modifiers will be appended to indicate whether the ordered exam adheres to AUC and whether any exceptions apply. – Whether the imaging service would adhere to the applicable AUC – Whether the imaging service would not adhere to the applicable AUC – Whether such criteria were not applicable to the imaging service ordered – Whether the imaging service was ordered for a patient with an emergency medical condition – Whether the ordering professional has a hardship exception. RadRx “Your Prescription for Accurate Coding & Reimbursement” 10 Copyright 2017. RadRx all rights reserved. Unauthorized distribution is prohibited. 5 11/30/2017 ‐FY Modifier • Reported on claims including codes that describe X‐ rays taken using computed radiography. – 7% reduction on payments for services between CY 2018 and CY 2022 – 10 % reduction in subsequent years • Required for the technical component, global billing. • When payment for X‐ray or computed radiography services are packaged into those for another item or service under the OPPS, there is no payment attributable to X‐ray or computed radiography, and therefore, there would be no corresponding payment reduction to either service. RadRx “Your Prescription for Accurate Coding & Reimbursement” 11 Copyright 2017. RadRx all rights reserved. Unauthorized distribution is prohibited. ‐CT Modifier • Modifier –CT “Computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (()NEMA) XE‐29‐2013 standard” • Beginning January 1, 2016 hospitals and suppliers were required to report the modifier ‐CT on claims for CT scans described by codes 70450‐70498, 71250‐ 71275, 72125‐72133, 72191‐72194, 73200‐73206, 73700‐73706, 74150‐74178, 74261‐74263, 75571‐75574 that are furnished on non‐NEMA Standard XR‐29‐ 2013‐compliant CT scanners. – The use of this modifier will result in the applicable payment reduction for the technical component of the CT service under MPFS and OPPS. In 2016, there was a 5% reduction and for 2017 and in subsequent years, it has increased to a 15% reduction. • The NEMA standards identify four key features of CT scanners which contribute to or help perform optimization and or management of doses of ionizing radiation while still enabling the system to dlideliver the diagnost ic image quality needdded by the physician. • Standards at https://www.nema.org/Standards/Pages/Standard‐Attributes‐on‐CT‐ Equipment‐Related‐to‐Dose‐Optimization‐and‐Management.aspx RadRx “Your Prescription for Accurate Coding & Reimbursement” 12 Copyright 2017. RadRx all rights reserved. Unauthorized distribution is prohibited. 6 11/30/2017 ‐FX Modifier • Appended to the CPT® code when film is used instead of digitally capturing the image – Used on Medicare claims – Hospital outpatient billing and physician technical/ global billing • Technical payment will be discounted 20% for 2017 and subsequent years RadRx “Your Prescription for Accurate Coding & Reimbursement” 13 Copyright 2017. RadRx all rights reserved. Unauthorized distribution is prohibited. NCCI POLICY MANUAL CHANGES: DIAGNOSTIC RADIOLOGY RadRx “Your Prescription for Accurate Coding & Reimbursement” 7 11/30/2017 Chapter 9, Section C Revised • 15. CPT code 77063 is an add‐on code describing screening digital tomosynthesis for mammography. This procedure requires performance of a screening mammography producing direct digital images. For calendar year 2017 Medicare allowed CPT code 77063 to be reported with HCPCS code G0202, not CPT code 77067. Beginning calendar year 2018 CPT code 77063 may be reported with CPT code 77067. (HCPCS code G0202 was deleted January 1, 2018. RadRx “Your Prescription for Accurate Coding & Reimbursement” 15 Copyright 2017. RadRx all rights reserved. Unauthorized distribution is prohibited. Chapter 9, Section E Chapter 12, Section C • 13. NCCI contains procedure to procedure (PTP) edits that bundle some radiopharmaceutical codes into nuclear medicine procedure codes. These code pairs represent radiopharmaceuticals that should not be reported with the nuclear
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