61055 Cisternal or lateral cervical
(C1-C2) puncture; with injection of medication or other
substance for diagnosis or
62284 Injection procedure for myelography and/or computed
tomography, lumbar (other
than C1-C2 and posterior
Four new comprehensive codes have
been established for myelogram contrast
injection and imaging.
62302 Myelography via lumbar injection, including radiological
supervision and interpretation;
62303 . . . thoracic
62304 . . . lumbosacral
62305 . . . 2 or more regions (eg, lum-bar/thoracic, cervical/thoracic,
These codes include the lumbar injection as well as the myelogram S&I. Note
that the existing myelogram S&I codes
(72240-74470) have not been deleted.
The American College of Radiology
(ACR) noted previously that these codes
would be retained since in some cases different physicians perform the injection
and the imaging guidance.
These new codes were discussed in the
September 2014 edition of CPT Assistant
and specific guidance was provided
regarding the reporting of traditional myelography in addition to a CT study. Myelography should not be reported just for
the documentation of needle placement,
but rather a complete procedure with full
imaging must be performed and documented. Also, “the supervision and interpretation for myelography should not be
reported without the referring physician or
other qualified healthcare professional
requesting an X-ray myelogram.” As of July
1, 2014, modifier 59 must be appended to
the CT of the spine if it is performed on
the same day as a traditional x-ray myelogram (old and new codes).
Code 74291 (Choleystography, oral contrast; additional or repeat examination or
multiple day examination) has been deleted.
The existing breast ultrasound code
(76645) has been deleted, and two new
codes have been created for complete and
76641 Ultrasound, breast, unilateral,
real time with image documentation, including axilla
when performed; complete
76642 . . . limited
Procedure code 76641 represents a
complete examination of the breast, which
includes all four quadrants of the breast
and the retroareolar region. By definition it
also includes an examination of the axilla,
if performed. The limited code, 76642, is
for a focused exam of the breast limited to
one or more of the elements included in
76641 and also the axilla, if performed.
There is a new note in the CPT® Manual
that directs the assignment of the limited
extremity code 76882 if only the axillary is
evaluated using ultrasound.
As with all ultrasound examinations,
there must be a thorough evaluation,
image documentation, and a final written
report or it is not separately reportable.
This is generally not an area of concern for
radiology practices and/or departments.
Ultrasound Guidance for RT
Code 76950 (Ultrasonic guidance for
placement of radiation therapy fields)
has been deleted.
Digital Breast Tomosynthesis (DBT)
Three new codes have been created for
screening and diagnostic DBT. The
screening DBT code is an add-on code
that will be reported together with the
screening mammogram code.
77061 Digital breast tomosynthesis;
77062 . . . bilateral
+77063 Screening digital breast tomosyn-
thesis, bilateral (List separately
in addition to code for primary
Procedure codes 77061 and 77062 may
not be reported with the regular screening
mammography code 77057 which may
create some challenges when you are
appropriately reporting screening and
diagnostic studies on the same date of service. There will be a lot more information
forthcoming regarding the coding and
reimbursement of mammography and
specifically DBT in the coming months.
Vertebral Fracture Assessment (VFA)
The existing vertebral fracture assessment
code (77082) has been deleted, and two
new VFA codes have been created. Code
77085 is a combination code that includes
axial DXA as well as vertebral fracture
assessment, while 77086 represents a stand-alone VFA. The existing codes for axial and
appendicular DXA studies (77080, 77081)
are not changing and will be used whenever
DXA is performed without VFA.
77085 Dual-energy X-ray absorptiom-etry (DXA), bone density study,
1 or more sites; axial skeleton
(eg, hips, pelvis, spine), including vertebral fracture assessment
via dual-energy X-ray absorpti-ometry (DXA)
The New Year always brings changes and
2015 is no different. The old adage is true,
the more things change, the more they
stay the same. So make sure that your
Charge Description Masters (CDM) are
updated, procedure pricing is appropriately updated, and appropriate system
changes are implemented to ensure that
you are capturing all of your charges
accurately and compliantly.
Melody W. Mulaik is president and co-founder of
Coding Strategies, Inc. She is a nationally recognized
speaker and has delivered numerous presentations at
AHRA annual meetings and conferences. Melody is a
member of AHRA, has published extensively, and may
be contacted at firstname.lastname@example.org.