Get ready for radiology code changes in 2020

Dec. 20, 2019 / By Katie Patterson, CPC

It’s that time of year again. Time to clean out the deleted CPT codes, bring in new codes, update and revise other codes. We will see some significant changes that will impact radiology in 2020, including 11 new radiology codes, 15 deleted codes and 20 revised codes. I believe the key to successfully implementing these changes not only lies with coder education, but also with physician education and template changes.

Let’s take some time to review the upcoming changes and the keys to successful radiology coding in 2020.

Gastrointestinal Radiology exams:

Deleted Codes: 74241, 74245, 74249, 74260
New Codes: 74221, 74248
Revised Codes: 74022, 74210, 74220, 74230, 74240, 74246, 74250, 74251, 74270, 74280

Interventional Radiology:

Deleted Code: 76930
New Code: None. Guidance is now inclusive.
Revised Codes: None

Nuclear Medicine Codes:

Deleted Codes: 78205, 78206, 78320, 78607, 78647, 78710, 78805, 78806, 78807
New Codes: 78430, 78431, 78432, 78433, 78434, 78830, 78831, 78832, 78835
Revised Codes: 78459, 78491, 78492, 78800, 78801, 78802, 78803, 78804

Now that you know the breakdown of changes, let’s review some of the key changes that will require an update to templates and documentation.

GI:

With the deletion of 74245 and 74249, the AMA has created add on code 74248 for the small intestine follow through portion of the study. 74248 will now be used in addition to 74240 and 74246 when the follow through portion is performed.

Templates Changes:

1. Remove old template for 74245 and 74249.
2. Add template for code 74246 Radiological examination, gastrointestinal tract, upper, air contrast, with specific high-density barium, effervescent agent, with or without glucagon.
3. Add template for code 74246, Radiological examination, gastrointestinal tract, upper, air contrast, with specific high-density barium, effervescent agent, with or without glucagon with add on code 74248 Radiologic small intestine follow-through study, including multiple serial images.

Documentation:

• Ensure the technique documents small intestine follow through when performed.

Nuclear Medicine:

The revision of code 78803 has inadvertently required the deletion of codes 78205, 78206, 78320, 78607, and 78710. Deletion of codes 78805-78807 (Radiopharmaceutical localization of inflammatory process) will change the coding strategy for localization of inflammatory process. Coders will now need to carefully select the appropriate CPT from one of the following, depending on the documentation provided: 78300, 78305, 78306, 78315, 78800, 78801, 78802, 78803, 78830, 78831, 78832.

Templates Changes:

1. Remove old templates for 78205, 78206, 78320, 78607, 78647 and 78710.
2. Update the current template for 78803 to include localization of inflammatory process and single area (e.g., head, neck, chest, pelvis), single day imaging.
3. Remove old templates for 78805-78807.
4. Review and revise templates for 78800-78804 to ensure the localization of inflammatory process is included.

Documentation:

• For 78803-78804: Ensure providers document localization of inflammatory process (when indicated), as well as the body area imaged and the days required for imaging.
• Educate providers to document localization of inflammatory process (when indicated) in the technique for 78800-78802.

Although we did not discuss every template and/or documentation update, I hope these examples demonstrate the necessity of a careful review of the upcoming code changes. Take the time to educate not only yourself, but also your providers and ancillary staff to ensure correct coding and clean claims moving into 2020.

Katie Kitchen is a senior coding analyst at 3M Health Information Systems.

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