Over the past couple of years, changes to the CPT manual affecting radiology haven’t been that drastic, but there are quite a few things that have changed for the radiology specialty for 2020. From code deletions to language revisions to essential modifiers for imaging claims to getting ready for Medicare’s Clinical Decisions Support (CDS) mandate going into effective for 2021, there’s a lot going on for this specialty.
Becoming familiar with all of these changes are essential, since failure to stay updated on new CPT codes or other changes can result in mistakes that lead to claim denials. But even worse, with some of the new changes to code descriptions for radiology codes, if you aren’t familiar with the coding changes you could have claims paid that shouldn’t be, and that can come back to haunt you later.
We’ve put together a look at some of the essential radiology-specific changes coming in 2020 and even looking down the road to 2021. This way you’re well equipped to avoid denials, payment delays, or other issues that can eat into your bottom line.
Code Deletions, Revisions, and Revisions
A variety of coding changes went into effect for 2020, and a handful of them do affect the radiology specialty. One deletion is the elimination of code 74241 (without or with delayed images, with KUB). Now you will be reporting a universal code for every single contrast study of the upper GI tract – code 74240. Related code deletions include the removal of the code for small intestine follow through (74249) and one with small intestine including serial images (74245). Instead of using these codes, there’s a new procedure code that will be used to report those small intestine follow-through studies with double- or single-contrast exams – Code 74248. You’ll need to list separately in addition to the code for the primary procedure.
Many of the changes occurring to 2020 radiology CPT codes aren’t actually deleted or new codes, but revisions to the existing codes, which can make things more difficult. Some of the revisions are total overhauls to codes, such as the revision for code 74022, which has been confusing in the past. New language notes that it’s a radiologic examination of the abdomen, a complete acute abdomen series that includes two or more abdominal views (erect, decubitus, and/or supine views, as well as a single view chest).
Other revisions that make it clearer what each service entails include the following:
- 74220 – Now states it’s a radiologic examination of the esophagus, which includes delayed image(s) and scout chest radiograph(s) when done; single contrast esophagus study.
- 74210 – Now says it’s a radiologic examination of the cervical esophagus and/or pharynx, including delayed image(s) and scout neck radiograph(s)when performed, a contrast study.
- 74230 – This code now specifically says it’s a swallowing radiologic exam, swallowing function along with videoradiography/cineradiography, which includes delayed image(s) and scout neck radiograph(s) and when performed, contrast study.
Essential Modifiers for Imaging Claims
Last July, a set of modifiers was released by Medicare that you should be using throughout 2020. They were released as a part of changes that relate to Appropriate Use Criteria for more advanced diagnostic imaging services. These new M-modifiers from Medicare include:
- Modifier MA – With this modifier, the ordering professional isn’t required to check with a clinical decision support mechanism because a service is being rendered to the patient with a confirmed or suspected emergency medical problem.
- Modifier MB – Due to significant hardship of internet access that’s insufficient, the ordering professional isn’t required to check with a clinical decision support mechanism.
- Modifier MC – Because of hardship caused by clinical decision support or electronic health record vendor issues, ordering professional isn’t required to check with the clinical decision support mechanism.
- Modifier MD – Uncontrollable and extreme circumstances create significant hardship and the ordering professional isn’t require to check with the clinical decision support mechanism.
- Modifier ME – The order for the service sticks with the appropriate use criteria that was provided by a clinical decision support mechanism which was consulted by an ordering professional.
- Modifier MF – The ordering professional consulted the clinical decision support mechanism, but the order for services doesn’t stick with the appropriate use criteria.
- Modifier MG – There isn’t an appropriate use criteria for the ordered service within the clinical decision support mechanism which the ordering professional consulted.
- Modifier MH – It’s unknown whether the clinical decision support mechanism was consulted by the ordering professional, related information wasn’t provided to the furnishing provider or professional.
Preparing for Medicare’s Clinical Decision Support (CDS) Mandate
Throughout 2020, even while there will be no penalty to radiologists this year, it’s essential to begin preparing for Medicare’s new Clinical Decision Support (CDS) mandate. According to those at Medicare, CDS offers many benefits, such as preventing adverse events and errors, improving efficiency, better patient satisfaction, improved provider satisfaction and increased quality of care, which results in better health outcomes.
According to Healthcare Administrative Partners, now is the time to figure out which radiologists may not be submitting the information that’s required. Throughout the year, Medicare will be giving feedback via message codes on claims that don’t contain CDS information throughout 2020. However, in 2021, radiologists won’t be paid for their claims unless they include the appropriate CDS information.
Spending some time early in the year reviewing changes and familiarizing yourself with how they affect your radiology practice can help you through the rest of the year. Of course, all the new codes, required modifiers, and additional changes can be tough to keep up with, which is where M-Scribe can help. We offer medical billing services, medical coding, payer contract review, and more, and we even work with all medical billing software providers so we can work with any practice. We specialize in staying up-to-date on changing rules, regulations, and codes, and we can work with you to reduce your workload and maximize your revenue. Contact M-Scribe today to learn more about how we can help you.