AMA and CMS recently released new Radiology and Interventional Documentation and Coding Updates for 2024. Please review these changes with your providers and revenue cycle management teams to ensure optimal performance in 2024.
1. CMS Carotid Revascularization Policy
2. CMS rescinds AUC/CDS
3. Upcoming 2024 CPT changes
1. CMS Policy Update – Carotid Revascularization, NCD 20.7
CMS has expanded coverage for Carotid Revascularization which will cover more patients under the following conditions:
- Effective 10/11/2023
- 50% symptomatic cervical carotid stenosis.
- 70% asymptomatic cervical carotid stenosis.
- Standard surgical risk instead of high surgical risk individuals.
- Neurologic assessment before and after carotid stent placement.
- Intra-arterial digital subtraction (catheter) angiography may be used only when there is significant discrepancy between noninvasive imaging results, or in lieu of CTA or magnetic resonance angiography if these are contraindicated.
- Requires formal shared decision-making interaction with the patient.
- Facility approval requirement removed; however, the facility is still required to have a program for granting privileges, monitoring outcomes, oversight committee, trained procedural and supporting staff and management, etc.
2. CMS AUC – CDS Rescinded
Effective January 1, 2024, CMS is pausing efforts to implement the Appropriate Use Criteria (AUC) program for reevaluation and rescinding the AUC regulations at 42 CFR 414.94, reserving this section for future use. CMS has not specified a timeframe within which implementation efforts will recommence. Appropriate Use Criteria Program | CMS.
Effective January 1, 2024, providers and suppliers should no longer include AUC consultation information on Medicare Fee for Service (FFS) claims. Additionally, CMS will no longer qualify Provider Led Entities (PLE) or Clinical Decision Support Mechanisms (CDSM) and will remove this information from the AUC website. The claims processing instructions and guidance for the educational and operations testing period will also be removed.
3. Sneak Peek 2024 CPT Changes
The annual AMA CPT Symposium takes place November 15-17. Details surrounding the new codes will become available during this meeting and will be communicated in our December blog.
Imaging Additions & One Deletion:
| CPT | Description | Former Category III Codes |
| 74710 DELETED | Pelvimetry, with or without placental localization | |
| 75580 | Noninvasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of the data set from a coronary computed tomography angiography, with interpretation and report by a physician or other qualified health care professional | 0501T
0502T 0503T 0504T DELETED |
| 76984 | Ultrasound, intraoperative thoracic aorta (eg, epiaortic), diagnostic | |
| 76987 | Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; including placement and manipulation of transducer, image acquisition, interpretation and report | |
| 76989 | Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; interpretation and report only | |
| 0815T | Ultrasound-based radiofrequency echographic multi-spectrometry (REMS), bone-density study and fracture-risk assessment, 1 or more sites, hips, pelvis, or spine | |
| 0857T | Opto-acoustic imaging, breast, unilateral, including axilla when performed, real-time with image documentation, augmentative analysis and report (List separately in addition to code for primary procedure) | |
| 0865T | Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR) study(ies), including lesion identification, characterization, and quantification, with brain volume(s) quantification and/or severity score, when performed, data preparation and transmission, interpretation and report, obtained without diagnostic MRI examination of the brain during the same session | |
| 0866T | Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR) study(ies), including lesion detection, characterization, and quantification, with brain volume(s) quantification and/or severity score, when performed, data preparation and transmission, interpretation and report, obtained with diagnostic MRI examination of the brain (List separately in addition to code for primary procedure) |
Procedure Additions & Deletions
| CPT | Description | Former Category III Codes |
| 58580 | Transcervical ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency | 0404T DELETED |
| 92972 | Percutaneous transluminal coronary lithotripsy (List separately in addition to code for primary procedure) | 0715T
DELETED |
| 93584 | Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; anomalous or persistent superior vena cava when it exists as a second contralateral superior vena cava, with native drainage to heart (List separately in addition to code for primary procedure) | |
| 93585 | Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; azygos/hemiazygos venous system (List separately in addition to code for primary procedure) | |
| 93586 | Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; coronary sinus (List separately in addition to code for primary procedure) | |
| 93587 | Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; venovenous collaterals originating at or above the heart (eg, from innominate vein) (List separately in addition to code for primary procedure) | |
| 93588 | Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; venovenous collaterals originating below the heart (eg, from the inferior vena cava) (List separately in addition to code for primary procedure) | |
| 0823T | Transcatheter insertion of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography) and device evaluation (eg, interrogation or programming), when performed | |
| 0824T | Transcatheter removal of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography), when performed | |
| 0825T | Transcatheter removal and replacement of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography) and device evaluation (eg, interrogation or programming), when performed | |
| 0826T | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional, leadless pacemaker system in single-cardiac chamber | |
| 0861T | Removal of pulse generator for wireless cardiac stimulator for left ventricular pacing; both components (battery and transmitter) | |
| 0862T | Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; battery component only | |
| 0863T | Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; transmitter component only |
References:
AMA/CPT, CMS
Appropriate Use Criteria Program | CMS.
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