2018 CPT Coding Updates

Each year the American Medical Association’s CPT code manual is revised to delete codes and/or guidelines, and to add or revise codes to reflect current technologies, techniques and services. Medicare and all other payers are switching to the new 2018 CPT codes for X-rays of the chest. The original codes for a chest X-ray were deleted and have been replaced with new codes. Practices should pay close attention to coding updates when performing or ordering imaging tests to ensure their billing aligns with the coding each payer will accept as systems are changed over. Below is the crosswalk of the codes from 2017 to 2018:

The reporting of chest X-rays will be defined solely by the number of views taken, so only four new codes will be used with nine codes being deleted, as follows:

New Codes for 2018:
71045 Radiologic examination, chest; 1 view chest
71046 Radiologic examination, 2 views chest
71047 Radiologic examination, 3 views chest
71048 Radiologic examination, 4 or more views

Deleted Codes for 2018:
71010 Radiologic examination, chest; single view, frontal
71015 Radiologic examination, stereo, frontal
71020 Radiologic examination, chest; 2 views, frontal and lateral;
71021 with apical lordotic procedure
71022 with oblique projections
71023 with fluoroscopy
71030 Radiologic examination, chest; complete, minimum of 4 views
71034 with fluoroscopy
71035 Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)

Ultrasound of Extremities
Also, although the coding for ultrasound of the extremities did not change, the definitions of CPT 76881 and 76882 have been revised.

CPT code 76881 was previously described as “Ultrasound Extremity, Complete” it will now become “Ultrasound Complete Joint.” The complete study code can be used when the examination evaluates the joint space and includes the surrounding soft tissues such as tendons or nerves.

Code 76882 will continue to be a limited exam of the joint, which means that either the joint space or the surrounding tissue was included, but not both. Permanently recorded images are required to be retained under either code, and the written report must clearly describe each of the elements that were evaluated in real time.

HCPCS Codes for Biosimilars
Also, as a result of advocacy efforts by the ACR and others stakeholders, Medicare has updated the HCPCS codes for Inflectra and Renflexia to have individual billing codes effective April 1, 2018. Practices should update their systems  to reflect the new Q codes: Inflectra is Q5103, and Renflexis is Q5104.

For questions or additional information on coding and billing updates, contact the ACR Practice Management Department at practice@rheumatology.org.