Ramp Up Your Revised Radiology Code Proficiency for 2019

Learn the latest NCDs for breast lumps—and new OB ultrasound codes

If you’re like most coders, you might be feeling a bit overwhelmed by all the coding changes on the horizon—such as the 2019 ICD-10-CM that takes effect October 1, 2018 and the upcoming CPT coding updates.

Coders of all specialties are in the same proverbial boat right now. But for radiology specifically, you’ve got a lot of new knowledge to juggle, radiology coding expert Stacie Buck points out in her 2019 Coding Updates Virtual Boot Camp for Diagnostic Radiology. In addition to ICD-10 and CPT revisions, you’ll also need to get up to speed on the recent CMS updates to National Coverage Determinations (NCDs) that directly impact radiology.

Revised: N63 and R93 Code Sets

Heads up: In Change Request (CR) 10622, CMS made several significant changes to NCD 220.13 Percutaneous Image-Guided Breast Biopsy and NCD 220.6.17 PET for Solid Tumors.

Effective Oct. 1, 2018, CMS has instructed Medicare Administrative Contractors (MACs) to add the following ICD-10 codes:

  • 10 — Unspecified lump in the right breast, unspecified quadrant; and
  • 20 — Unspecified lump in the left breast, unspecified quadrant.

Pro tip: You can report dual diagnosis codes depicting specific quadrants instead of unspecified quadrants if you find a more appropriate code, according to the American College of Radiology (ACR).

What’s more: CMS also instructed MACs to add back and revise the effective dates for the following CPT and ICD-10 codes:

  • 78608 — Brain imaging, positron emission tomography (PET); metabolic evaluation
  • 4 — Abnormal findings on diagnostic imaging of urinary organs
  • 41 — Abnormal findings on diagnostic imaging of renal pelvis, ureter, or bladder
  • 421 — Abnormal findings on diagnostic imaging of right kidney
  • 422 — Abnormal findings on diagnostic imaging of left kidney
  • 49 — Abnormal findings on diagnostic imaging of other urinary organs

Revised: MRIs for Medicare beneficiaries with Implanted Devices

These changes came on the heels of an updated NCD that allows Medicare beneficiaries with implanted pacemakers or cardioverter defibrillators to receive magnetic resonance imaging (MRI) under certain conditions. ACR clarified that beneficiaries can receive the MRI under “direct supervision” of a “qualified clinician,” but that the clinician doesn’t have to be present in the MRI suite/lab for the duration of the MRI.

Code this way: The policy does require, however, that the device be reinterrogated immediately after the MRI to confirm proper function. For this, you should code:

  • 93286 — Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system; or
  • 93287 — …single, dual, or multiple lead implantable defibrillator system.

If the same clinician performs both pre- and post-MRI evaluations, you should report the CPT code twice, ACR instructed. If one clinician performs the pre-MRI service and a different clinician performs the post-MRI evaluation, each clinician would bill once.

Use New Ultrasound ICD-10 Codes

Big news: The revised ICD-10 codes for FY 2019 are out, now along with the guidelines. CMS added some codes that impact radiology, such as the following new codes in Chapter 18 (Symptoms, Signs and Abnormal Clinical and Laboratory):

  • 81 — Abnormal radiologic findings on diagnostic imaging of testis
    • 811 — …of right testicle
    • 812 — …of left testicle
    • 813 — …of testicles, bilateral
    • 819 — …of unspecified testicle
    • 89 — …of other specified body structures

Also: For obstetrics ultrasounds, keep in mind that CMS added the following ICD-10 codes to Chapter 15 (Pregnancy, Childbirth and the Puerperium), which deal with multiple gestations. Heed these OB ultrasound code changes:

  • 13 — Triplet pregnancy, trichorionic/triamniotic
    • 131 — …first trimester
    • 132 — …second trimester
    • 133 — …third trimester
    • 139 — …unspecified trimester
  • 23 — Quadruplet pregnancy, quadrachorionic/quadra-amniotic
    • 231 — …first trimester
    • 232 — …second trimester
    • 233 — …third trimester
    • 239 — …unspecified trimester
  • 83 — Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses
    • 831 — …first trimester
    • 832 — …second trimester
    • 833 — …third trimester
    • 839 — …unspecified trimester

Prepare for What’s Next

Remember: The 2019 ICD-10-CM codes are effective October 1, 2018, and you should use the updated codes for discharges or patient encounters occurring from Oct. 1, 2018 through Sept. 30, 2019. The new CPT codes take effect on January 1, 2019.

Radiology coding is no easy task. You need to stay abreast of the latest ICD-10 and CPT coding changes for 2019 to capture deserved reimbursement and avoid compliance problems, Buck warns. Make sure you understand all the new, revised, and deleted codes that impact radiology.

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