There are many CPT codes added in 2019. There are around 168 new cpt codes added this year. We have learnt about few of them in my previous post. 

Today we will learn about the new cpt codes added for coding Elastography. There are three new CPT code 76981, 76982 & 76983 has been added for coding elastography. The old code 0346T was been deleted in 2019

Elastography is a newer technique that exploits the fact that a pathological process alters the elastic properties of the involved tissue. This change in elasticity is detected and imaged using elastography.

Read also: Coding tips for MRI breast exam CPT codes

Code description of CPT code 76981, 76982 & 76983

As discussed earlier, elastography is a procedure, performed using ultrasound (US) to measure the elastic properties of soft tissue, such as the parenchyma of an organ, or lesion(s) within a soft tissue organ. This imaging technique may be used to obtain diagnostic information regarding diseases of structures such as the liver, breast, thyroid, prostate, and muscles.

76981 (new)  Ultrasound, elastography; parenchyma (eg, organ)

76982 (new)  Ultrasound, elastography; first target lesion

76983 (new)  Ultrasound, elastography; each additional target lesion (List separately in addition to code for primary procedure)

0346T (deleted) Ultrasound, elastography (List separately in addition to code for primary procedure)

CPT code 76981 is used to report  elastography ultrasound evaluation of a parenchymal organ and any specific lesions within that same organ. CPT code 76982 is used for elastography ultrasound evaluation of a specific soft tissue lesion only or the first lesion in another organ, and 76983 for each additional target lesion.

• Report CPT code 76983 only along with procedure code 76982
• CPT code 76981 should be reported only once per session for evaluation of the same parenchymal organ
• Do not report CPT code 76983 more than two times per organ

In September 2017, the CPT Editorial Panel created three new codes describing the use of ultrasound elastography to assess organ parenchyma and focal lesions: CPT codes 76981, 76982 and 76983. The most common use of this code set will be for preparing patients with disease of solid organs, like the liver, or lesions within solid organs. The additional work involved is the physiologic assessment of a diseased organ, the technical ability to evaluate the elastography data, and the training to understand the physics and appropriate quality control for elastography in addition to diagnostic ultrasound.

NCCI edits for CPT code 76981, 76982, 76983

76981 Ultrasound, elastography; parenchyma (eg, organ)

The RUC reviewed the survey results from 53 radiologists and determined that the survey 25th percentile work RVU of 0.59 accurately reflects the physician work necessary for this service. CPT code 76981 is a new, stand-alone code describing the evaluation of a solid organ using ultrasound elastography. The specialty explained that the physician is examining and evaluating the imaging of the organ and 7-10 sets of elastography images. The RUC recommends 5 minutes pre-service time, 10 minutes intra-service time and 5 minutes immediate post-service time. These pre and post-service times align with other comparable ultrasound and diagnostic radiology codes.

The RUC compared CPT code 76981 to the second highest key reference service CPT code 76705
Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, followup) (work RVU = 0.59 and 8 minutes intra-service time) and agreed that the physician work is similar to
an abdominal ultrasound study. The specialty noted that the physician intra-service work in evaluating the patient directly and interpreting the images and making the clinical judgment is different work than is being performed in the limited or complete ultrasound. The radiologist interprets all images and evaluates stiffness measurements of the parenchyma of interest. The current exam is compared to any prior examinations to evaluate for stability or interval changes. The RUC also reviewed the top key reference service CPT code 76700 Ultrasound, abdominal, real time with image documentation; complete (work RVU = 0.81 and 11 minutes intra-service time) and noted that the complete abdominal ultrasound requires more measurements and the recommended value of 0.59 for CPT code 76981 is appropriately lower given the lower intra-service time for the survey code. The RUC concluded that CPT code 76981 should be valued at the 25th percentile as supported by the survey. The RUC recommends a work RVU of 0.59 for CPT code 76981.

76982 Ultrasound, elastography; first target lesion
The RUC reviewed the survey results from 34 radiologists and determined that the survey 25th percentile work RVU of 0.59 accurately reflects the physician work necessary for this service. CPT code 76982 is a new stand-alone code describing the evaluation of a specific lesion within an organ, like a nodule in the breast, using ultrasound elastography. Approximately 3-5 sets of images are obtained and the components of the lesion are evaluated. The RUC recommends 5 minutes pre-service time, 10 minutes intra-service time and 5 minutes immediate post-service time as supported by the survey.
The RUC compared CPT code 76982 to the top key reference service CPT code 76776 Ultrasound,
transplanted kidney, real time and duplex Doppler with image documentation (work RVU = 0.76 and 10 minutes intra-service time). The reference code is a dedicated evaluation of a single organ, just like 76982 is a dedicated evaluation of a specific lesion. Both of these procedures have the same pre-, intra-, and post-service times; however, given the slightly higher complexity of evaluating a transplant kidney relative to the elastography of a single lesion, it is clinically appropriate that 76776 have a higher work RVU and IWPUT than the survey code.

The RUC also compared 76982 to the second highest key reference service CPT code 76536 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation (work RVU = 0.56 and 10 minutes intra-service time) and noted that the codes have nearly identical values and times.

The reference code has 2 minutes less of preservice and post-service time and is a relatively less complex imaging exam than 76982, justifying a slightly higher work RVU for the survey code.
For additional support, the RUC compared the survey code to the third highest reference code 76882 Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft tissue structure[s], or soft tissue mass[es]), real-time with image documentation (work RVU = 0.49 and 11 minutes intra-service time) and noted that the recommended value of 0.59 for CPT code 76982 is appropriately higher than the comparator code given the survey code is more complex.

The RUC concluded that CPT code 76982 requires the same physician time and work as 76981 and therefore should be valued the same. The RUC recommends a work RVU of 0.59 for CPT code 76982.

76983 Ultrasound, elastography; each additional target lesion (List separately in addition to code for primary procedure)
The RUC reviewed the survey results from 32 radiologists and recommends a work RVU of 0.50 which is based on a direct work RVU crosswalk to CPT code 15276 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure) (work RVU = 0.50 and 10 minutes intra-service time) and falls well below both the survey median and 25th percentile.

CPT code 76983 is a new add-on code that describes the evaluation of an additional lesion using ultrasound elastography. The RUC recommends 9 minutes intra-service time.
The RUC compared CPT code 76983 to the top key reference service CPT code 76802 Ultrasound,
pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) (work RVU = 0.83 and 10 minutes intra-service time) and noted that both services are diagnostic imaging exams using the same modality (ultrasound) with relatively similar intra-service time.

The reference code is correctly valued higher than 76983 because the complexity of assessing a twin gestation and the associated risks, are higher than the evaluation of a single lesion. The RUC agrees with the direct crosswalk recommendation of 0.50 work RVUs and noted that CPT code 76983 needed to be valued lower than the recommendations for the other two codes in order to avoid a rank order anomaly within the family. The RUC recommends a work RVU of 0.50 for CPT code 76983.

References:

https://www.ama-assn.org/system/files/2018-11/4-jan-2018-ruc-meeting-minutes_0.pdf