2022 CPT Changes: Radiology

2022 Radiology CPT code changes
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2022 CPT Changes: Radiology

Trabecular Bone Score (77089-77092)

 

  • TBS is a measurement of the structural condition of the bone microarchitecture.

  • It is different than bone mineral density (DXA).

  • TBS can be performed on data output from either DXA or digital X rays.

  • Generally, the data is sent off for analysis; however, the analysis can be performed on site if the facility has the TBS software

  • This service is complimentary to Dexa

  • TBS may predict the risk of major osteoporotic fracture independently of bone mineral density (BMD) and clinical risk factors.

77089
Trabecular bone score (TBS), structural condition of the bone microarchitecture; using dual X-ray absorptiometry (DXA) or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture-risk (Pro fee)

77090  
Technical preparation and transmission of data for analysis to be performed elsewhere (TC)

77092
Interpretation and report on fracture-risk only by other qualified health care professional

Documentation should include:

 

  • Trabecular bone score (TBS), performed for “fracture risk”

  • Interpretation and report by the radiologist

  • Technical preparation and transmission of data for analysis to be performed elsewhere

  • Technical calculation only

  • Interpretation and report by other qualified health care professional (ie; PA,NP)

Category III Codes

 

  • Used for new and emerging technology

  • Data collection purposes

  • Generally, no RVU’s

Quantitative Ultrasound Tissue Characterization (Non-Elastographic) (0689T, 0690T)

 

  • This code should not be used for elastography

  • These new codes (0689T and 0690T) have been established to report quantitative (measurement) with ultrasound for tissue characterization obtained without (0689T) or with (0690T) a separate diagnostic ultrasound examination of the same anatomy.

  • This procedure analyzes (measures) the reflected ultrasound beam in order to better characterize tissue.

  • For instance, it can be used to look at

    •  the liver for fat content.

    •  the breast to separate benign from malignant masses.

    •  the eye to separate benign from malignant masses.

  • These codes allow users to report these codes to either

    • independently as a separate procedure or

    •  as an add-on code with other diagnostic ultrasound codes

  • However, these codes 0689T and code 0690T cannot be reported together

0689T
Quantitative ultrasound tissue characterization (non-elastographic), including interpretation and report, obtained without diagnostic ultrasound examination of the same anatomy (e.g., organ, gland, tissue, target structure)

Code 0690T is the most common service

+•0690T
Quantitative ultrasound tissue characterization (non-elastographic), including interpretation and report, obtained with diagnostic ultrasound examination of the same anatomy (e.g., organ, gland, tissue, target structure) (List separately in addition to coding for primary procedure)

Assistive Augmented Intelligence Analysis for Vertebral Fractures (0691T)

 

  • Software program used to analyze data from an existing data set

  • The analysis uses an existing computed tomography (CT) data set for vertebral fractures, including assessment of bone density when performed, data preparation, transmission, interpretation and report.

  • Code 0691T uses a previously acquired CT dataset whether performed at the same institution or an outside institution.

  • The purpose of this code is to detect subtle vertebral fractures (not for the risk for fractures codes 0554T-0556T.)

  • Must meet medical necessity

  • Cannot be performed at the same time as the original CT

  • This code describes analysis that can be performed days, weeks or even months after the original CT.

  • This service must specifically be ordered for analysis of vertebral fractures

  • The original CT must be ordered and performed for a different clinically indicated reason (i.e., malignancy, renal stone, etc.)

  • Caution – This service would not be applied universally to every study performed, but rather performed for individuals with a baseline high pre-test probability (e.g., elderly patients with suspected osteoporosis or patients on steroid therapy).

  • This is a separate service from the original CT and must be explicitly requested after the fact.

  • Do not report 0691T with other CT codes.

0691T
Automated analysis of an existing computed tomography study for vertebral fracture(s), including assessment of bone density when performed, data preparation, interpretation, and report

Quantitative Multiparametric Magnetic Resonance (0648T-0649T)

While these codes were effective July 1, 2021, the code descriptions were revised to differentiate single- and multiple-organ analysis.

  • These two new codes were established to report quantitative magnetic resonance analysis of tissue composition including multiparametric data acquisition, data preparation and transmission, interpretation and report, without diagnostic magnetic resonance imaging (MRI) (0648T) and with diagnostic MRI as an add-code (0649T).

  • This software takes existing MR images and analyzes the data to quantify (measure) a particular characteristic (i.e., liver fat, fibro-inflammatory disease, pancreas fat, pancreas fibrosis, cardiac fibrosis, lung capacity or others)

  • If the purpose of the study is to bring the patient in and perform multiple parameter measurements of the area of interest, assign codes 0648T or 0649T.

  • A diagnostic MR should not be assigned.

0648T
Quantitative magnetic resonance for analysis of tissue composition (e.g., fat, iron, water content), including multiparametric data acquisition, data preparation and transmission, interpretation and report, obtained without diagnostic MRI examination of the same anatomy (e.g., organ, gland, tissue, target structure) during the same session

+•0649T
Quantitative magnetic resonance for analysis of tissue composition (e.g., fat, iron, water content), including multiparametric data acquisition, data preparation and transmission, interpretation and report, obtained with diagnostic MRI examination of the same anatomy (e.g., organ, gland, tissue, target structure) (List separately in addition to code for primary procedure)

3D Volumetric Imaging of Breast Specimen (0694T)

 

  • A new Category III code (0694T) has been added to report real-time intraoperative 3D volumetric imaging of breast or axillary lymph node tissue.

  • Code 0694T reports technology that can be used during surgery, such as a lumpectomy, to aid the physician in analyzing the excised specimen to determine if additional tissue needs to be excised.

  • Code 0694T is reported one time for each excised specimen.

0694T
3-dimensional volumetric imaging and reconstruction of breast or axillary lymph node tissue, each excised specimen, 3-dimensional automatic specimen reorientation, interpretation and report, real-time intraoperative

Noninvasive Arterial Plaque Quantification (0710T- 0713T)

 

  • Analyzes structural and composition biomarkers of atherosclerotic plaque stability

  • Derived from computed tomography angiography (CTA)

  • Use of software to analyze data from CTA

  • Quantification of structure, composition of vessel wall

  • Assessment for lipid-rich necrotic core plaque – assess atherosclerotic plaque stability

  • This code is restricted to Non-Coronary imaging

  • These codes are not to be coded with CTA FFR codes (0501T-0504T)

0710T
Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; including data preparation and transmission, quantification of the structure and composition of the vessel wall and assessment for lipid-rich necrotic core plaque to assess atherosclerotic plaque stability, data review, interpretation and report

0711T
Data preparation and transmission data preparation and transmission

0712T
Quantification of the structure and composition of the vessel wall and assessment for lipid-rich necrotic core plaque to assess atherosclerotic plaque stability

0713T
Data review, interpretation and report

Deleted Codes

72275
Epidurography, radiological supervision and interpretation

  • It was determined that Radiology is no longer the dominant reporting provider based on utilization data reviewed by the AMA/Specialty Society Relative Value Scale (RVS) Update Committee (RUC)
  • Physician work was found to be encompassed in other codes (injection for procedure 62263 and 62264 codes)

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