Coding Q&A By Julie C. Bulman, MD, RPVI CPT coding changes for 2024
For the upcoming year, there are some changes to the code set that affects interventional radiology: two new procedural codes, revisions to the evaluation and management (E/M) code set, and two deleted codes.
Dorsal sacroiliac arthrodesis A new code (27278) has been created to describe percutaneous placement of an intra-articular stabilization device into the sacroiliac joint using a minimally invasive technique that does not transfix the sacroiliac joint. This code is inclusive of all image guidance. For arthrodesis of the sacroiliac joint that does include placement of a percutaneous transfixation device, code 27279 should still be used. If a bilateral procedure is done, 27278 should be reported with modifier –50.
Proximal femur osteo-enhancement procedure A Category III code (0814T) has been created for the percutaneous injection of calcium-based biodegradable osteoconductive material into the proximal femur. This is a unilateral code and is inclusive of all image guidance.
E/M coding Guidelines have been revised in various E/M codes for clarification purposes. Below are the coding changes pertinent to clinical IR.
Office outpatient services Office or other outpatient codes 99202–99205 (new patient) and 99212–99215 (established patient) have been revised to replace total time ranges with a minimum of total time that must be met or exceeded.
Hospital inpatient or observation care services (including admission and discharge services) The guidelines have been revised to be consistent with CMS policy. They now clarify that codes 99234–99236 are only reported when the length of stay is more than 8 hours and when the same physician, or other quality health policy team, performs both the initial hospital inpatient or observation care and discharge services. The revised guidelines also clarify how to report lengths of stay that are fewer than 8 hours. Guidelines were also revised by replacing the term “encounter” with “visits.”
Split or shared visits Split or shared E/M visits are defined as E/M services provided jointly between a physician and a nonphysician provider, who both work in the same group and same specialty. These visits can be for new or established patients in the facility setting. In 2024, clarification has been provided whether you are reporting using time or medical decision-making (MDM).
When time is used for code selection for an E/M share-visit service, the E/M service is reported by the professional who spent the majority of the time performing the service.
When MDM is used for code selection for an E/M shared-visit service, the E/M service is reported by the professional who made or approved the patient’s management plan for the number and complexity of problems addressed at the encounter and also takes responsibility for that plan with its inherent risk of complications of patient management.
Deleted Codes 74710
0775T Pelvimetry, with or without placental localization
Arthrodesis, sacroiliac joint, percutaneous, with image guidance, includes placement of intra-articular implant(s) (e.g., bone allograft[s], synthetic device[s])
16 IRQ | WINTER 2024
Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2023/CPT®). It is not comprehensive and does not replace CPT®. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the definitions of the CPT® descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service. Please refer to 2023 CPT® for full and complete guidelines.
Every reasonable effort has been made to ensure the accuracy of this guide; but SIR and its employees, agents, officers and directors make no representation, warranty or guarantee that the information provided is error-free or that the use of this guide will prevent differences of opinion or disputes with payers. The publication is provided “as is” without warranty of any kind, either expressed or implied, including, but not limited to, implied warranties or merchantability and fitness for a particular purpose. The company will bear no responsibility or liability for the results or consequences of the use of this manual. The ultimate responsibility for correct use of the Medicare and AMA CPT® billing coding system lies with the user. SIR assumes no liability, legal, financial or otherwise for physicians or other entities who utilize the information in this guide in a manner inconsistent with the coverage and payment policies of any payers, including but not limited to Medicare or any Medicare contractors, to which the physician or other entity has submitted claims for the reimbursement of services performed by the physician.
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