review of msk radiograph coding changes in 2016 jason w. stephenson m.d. university of wisconsin...

Review of MSK Radiograph Coding Changes in 2016

Jason W. Stephenson M.D.University of Wisconsin School of Medicine and

Public HealthDepartment of Radiology

Overview

Changes have been made to several CR codes in order to:• Further align coding convention and typical

clinical practice.• Simplify coding for radiologists and

technologists

Overview

• CPT codes are periodically updated and revised by the AMA.

• Codes can be updated in the following ways:1. Revision of an existing code2. Deletion of an existing code3. Creation of an entirely new code

Overview

Updates this year consist of:1. A revision of the thoracolumbar spine

radiograph code definition2. Deletion of all existing scoliosis codes and

addition of new scoliosis codes3. Deletion of all existing hip codes and addition of

new hip/pelvis codes4. Deletion of the existing femur code sets and

addition of new femur codes

1. Thoracolumbar spine72080

X-RAY EXAM THORACOLMB 2 VW

72080

X-RAY EXAM THORACOLMB 2/> VW

OLD

• The only existing thoracolumbar spine code has been revised to accommodate studies with more than two views.

• This should not change radiologist practice in any meaningful way.

2. Scoliosis Codes72010

X-RAY SPINE SURVEY AP & LAT VIEWS

OLD

72090X-RAY SCOLIOSIS SUPINE & ERECT

OLD

72069X-RAY SCOLIOSIS STANDING

OLD

• Old scoliosis code sets depend on the position of the patient and, to a lesser, extent, the number of views.

• These codes became confusing when one study combined positions specified in multiple code descriptions

• All of these code will be deleted on 12/31/15

72010X-RAY SPINE SURVEY AP & LAT VIEWS

OLD

72090X-RAY SCOLIOSIS SUPINE & ERECT

OLD

72069X-RAY SCOLIOSIS STANDING

OLD

2. Scoliosis Codes• New scoliosis CR codes only regard the number

of unique views regardless of what these views happen to be and in what context they were obtained.

2. Scoliosis Codes

72081Xray Entire Spine 2-3 view (eg Scoli)

72082Xray Entire Spine 1 view (eg Scoli)

72083Xray Entire Spine 4-5 view (eg Scoli)

72084Xray Entire Spine >= 6 view (eg Scoli)

• New codes only regard the number of unique views regardless of what these views happen to be.

• New scoliosis CR codes only regard the number of unique views regardless of what these views happen to be and in what context they were obtained.

3. Hip Codes73500

X-RAY HIP UNILATERAL >= 2 VIEWS [Laterality]

OLD

73520X-RAY PELVIS W BOTH HIPS PEDSX-RAY

OLD

73510X-RAY HIP UNILATERAL >= 2 VIEWS [Laterality]

OLD 73540X-RAY PELVIS W BOTH HIPS PEDS

OLD

73530HIP INTRAOPERATIVE [Laterality]

OLD

• Distinguishing between peds and adult exams became problematic

• Pelvis and hips are frequently performed in combination resulting in coding ambiguity


3. Hip Codes73500

X-RAY HIP UNILATERAL >= 2 VIEWS [Laterality]

OLD

73520X-RAY PELVIS W BOTH HIPS PEDSX-RAY

OLD

73510X-RAY HIP UNILATERAL >= 2 VIEWS [Laterality]

OLD 73540X-RAY PELVIS W BOTH HIPS PEDS

OLD

73530HIP INTRAOPERATIVE [Laterality]

OLD

• Distinguishing between peds and adult exams became problematic

• Pelvis and hips are frequently performed in combination resulting in coding ambiguity


New hip CR codes:• Allow the option for a view of the pelvis to be

included as part of the hip exam• Determined based on the number of unique views

AND whether both hips are included on non-pelvis images

• Do not distinguish between pediatric and adult patients

3. Hip Codes

73501Xray Hip Unilateral 1 view [Laterality]

75302Xray Hip Unilateral 2-3 views [Laterality]

73503Xray Hip Unilateral >= 4 views [Laterality]

Unilateral Group*

*Except for pelvis image, only one hip included

New hip CR codes:• Allow the option for a view of the pelvis to be included• Determined based on the number of unique views AND whether both

hips are included on non-pelvis images• Do not distinguish between pediatric and adult patients

3. Hip Codes

73521Xray Hip Bilateral 2 views

75322Xray Hip Bilateral3-4 views



73523Xray Hip Bilateral>= 5 views

Bilateral Group*

*Excluding pelvis image, exam must include unique images of each hip

3. Hip Codes

Note:Pelvis only codes are not effected by these revisions (e.g. Pelvis 1-2 views, Pelvis >= 3 views)



4. Femur Codes

73550X-RAY FEMUR 2 VIEWS [Laterality]

OLD

73551Xray Femur Unilateral 1 view

73552Xray Femur Unilateral >= 2 views

• The old codes did not readily accommodate multiple varieties of femur CR exams

• The old “2 view” femur code will be deleted and replaced by two new codes

Case Example1

Using new coding convention, what code corresponds to this set of images? *

Answer1Xray Hip Unilateral 2-3 views Right (73502)• One view pelvis plus reray and

singe view of the right hip for a total of 2 unique views (includes the pelvis – reray does not count as a unique view)

• Note that it actually does not matter how you regard the reray in this case as the code would still be the same if you considered this to be 3 unique views*

*This is a reasonable and defensible position

Case Example2Click Here to View Pertinent

Code Set

Answer2Xray Entire Spine 1 view (eg Scoli) (72081)• Composite views and long

cassette display comprise one unique view of the entire spine.

• Pt’s supine position identifies a single unique view but is otherwise irrelevant

• Intra-operative status is irrelevant

Case Example3

Answer3Pelvis 1-2 views (72170)• This is an AP pelvis and a

reray AP pelvis. As such the most appropriate code is the existing and unchanged pelvis 1 or 2 view code.

• If unique views of either or each hip were also performed, then one of the new hip codes would be used instead.

Case Examples4

*

Answer4Xray Entire Spine 4-5 view (eg Scoli) (72083)• Braced and non-braced represent

unique exam conditions and, accordingly, unique views.

• This results in four unique views• Pediatric status is irrelevant

Case Example5

*

Answer5Xray Hip Bilateral 3-4 views (75522)• Unique views of each hip

are included (two of the right hip, one of the left) in addition to an AP pelvis

• Four total views including the pelvis

Answer6

*

Case Example6Xray Hip Bilateral minimum 5 views (75523)• Unique views of each hip

are included (two of the right hip, two of the left) in addition to an AP pelvis

• Five total views including the pelvis

Case Example7

*

¿Answer? – Option 17Pelvis 1-2 views (72170)• Pediatric status is

irrelevant• No separate views of

either hip.• Please note: This

represents a downstream change in coding practice resulting from aforementioned code revisions

¿Answer? – Option 27Xray Hip Bilateral 2 views (75302)• Pediatric status is

irrelevant• Assumes second image is

a view of bilateral hips• Please note: This

represents a downstream change in coding practice resulting from aforementioned code revisions

Other Odd Gray Area

73501Xray Hip Unilateral 1 view [Laterality]

• This code could, in theory be used to for a single view pelvis given the language of the code description.

• We will continue to use the 72170 Pelvis 1-2 views code for a single view of the pelvis

review of msk radiograph coding changes in 2016 jason w. stephenson m.d. university of wisconsin...

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