1. Review of MSK Radiograph Coding Changes in 2016 Jason W. Stephenson M.D. University of Wisconsin School of Medicine and Public Health Department of Radiology

2. 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

3. Overview CPT codes are periodically updated and revised by the AMA. Codes can be updated in the following ways: 1.Revision of an existing code 2.Deletion of an existing code 3.Creation of an entirely new code

4. Overview Updates this year consist of: 1.A revision of the thoracolumbar spine radiograph code definition 2.Deletion of all existing scoliosis codes and addition of new scoliosis codes 3.Deletion of all existing hip codes and addition of new hip/pelvis codes 4.Deletion of the existing femur code sets and addition of new femur codes

5. 1. Thoracolumbar spine 72080 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.

6. 2. Scoliosis Codes 72010 X-RAY SPINE SURVEY AP & LAT VIEWS OLD 72090 X-RAY SCOLIOSIS SUPINE & ERECT OLD 72069 X-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

7. 72010 X-RAY SPINE SURVEY AP & LAT VIEWS OLD 72090 X-RAY SCOLIOSIS SUPINE & ERECT OLD 72069 X-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.

8. 2. Scoliosis Codes 72081 Xray Entire Spine 2-3 view (eg Scoli) 72082 Xray Entire Spine 1 view (eg Scoli) 72083 Xray Entire Spine 4-5 view (eg Scoli) 72084 Xray 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.

9. 3. Hip Codes 73500 X-RAY HIP UNILATERAL >= 2 VIEWS [Laterality] OLD 73520 X-RAY PELVIS W BOTH HIPS PEDSX-RAY OLD 73510 X-RAY HIP UNILATERAL >= 2 VIEWS [Laterality] OLD 73540 X-RAY PELVIS W BOTH HIPS PEDS OLD 73530 HIP INTRAOPERATIVE [Laterality] OLD Distinguishing between peds and adult exams became problematic Pelvis and hips are frequently performed in combination resulting in coding ambiguity All of these code will be deleted on 12/31/15

10. 3. Hip Codes 73500 X-RAY HIP UNILATERAL >= 2 VIEWS [Laterality] OLD 73520 X-RAY PELVIS W BOTH HIPS PEDSX-RAY OLD 73510 X-RAY HIP UNILATERAL >= 2 VIEWS [Laterality] OLD 73540 X-RAY PELVIS W BOTH HIPS PEDS OLD 73530 HIP INTRAOPERATIVE [Laterality] OLD Distinguishing between peds and adult exams became problematic Pelvis and hips are frequently performed in combination resulting in coding ambiguity All of these code will be deleted on 12/31/15

11. 3. Hip Codes 73500 X-RAY HIP UNILATERAL >= 2 VIEWS [Laterality] OLD 73520 X-RAY PELVIS W BOTH HIPS PEDSX-RAY OLD 73510 X-RAY HIP UNILATERAL >= 2 VIEWS [Laterality] OLD 73540 X-RAY PELVIS W BOTH HIPS PEDS OLD 73530 HIP INTRAOPERATIVE [Laterality] OLD Distinguishing between peds and adult exams became problematic Pelvis and hips are frequently performed in combination resulting in coding ambiguity All of these code will be deleted on 12/31/15 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

12. 3. Hip Codes 73501 Xray Hip Unilateral 1 view [Laterality] 75302 Xray Hip Unilateral 2-3 views [Laterality] 73503 Xray 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

13. 3. Hip Codes 73521 Xray Hip Bilateral 2 views 75322 Xray Hip Bilateral 3-4 views 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 73523 Xray Hip Bilateral >= 5 views Bilateral Group* *Excluding pelvis image, exam must include unique images of each hip

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

15. 4. Femur Codes 73550 X-RAY FEMUR 2 VIEWS [Laterality] OLD 73551 Xray Femur Unilateral 1 view 73552 Xray 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

16. 4. Femur Codes 73550 X-RAY FEMUR 2 VIEWS [Laterality] OLD 73551 Xray Femur Unilateral 1 view 73552 Xray 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

17. Case Example 1 Using new coding convention, what code corresponds to this set of images? *

18. Answer 1 Xray 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

19. Case Example 2 Click Here to View Pertinent Code Set

20. Answer 2 Xray 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

21. Case Example 3

22. Answer 3 Pelvis 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.

23. Case Examples 4 *

24. Answer 4 Xray 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

25. Case Example 5 *

26. Answer 5 Xray 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

27. Answer 6 *

28. Case Example 6 Xray 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

29. Case Example 7 *

30. ¿Answer? – Option 1 7 Pelvis 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

31. ¿Answer? – Option 2 7 Xray 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

32. Other Odd Gray Area 73501 Xray 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