Radiology first felt the effects of the bundling initiative launched by CMS in 2010, with the creation of combined CPT® codes for myocardial perfusion, wall motion, and ejection fraction (78451–78454); arteriovenous shunt dialysis-catheter procedures, along with radiological supervision and interpretation (36147 and 36148); and facet-joint injection procedures that include imaging guidance (64490–64495).
For 2011, CMS escalated the activity with three new targets, including the newly bundled codes for CT exams of the abdomen and pelvis (74176, 74177, and 74178); lower-extremity revascularization codes that include accessing and catheterizing the vessel traversing the lesion, radiological supervision and interpretation, embolic protection, closure of the arteriotomy (by any method), imaging performed to document completion of the intervention (as well as the interventions performed), and moderate conscious sedation (37220–37235); and atherectomy above the inguinal ligaments, including radiological supervision and interpretation (0234T–0238T).
An ACR communication1 reminds radiologists that this initiative is affecting all of medicine, that the ACR is compelled to participate in the process, and that it is constrained from reporting on the deliberations. “While the ACR is not permitted to provide detailed information on the codes and descriptors developed for 2012 at this time, we can inform our members of codes being considered for bundling,” the communication says
It also notes that in response to provider requests, the AMA will issue the 2012 version of the CPT codes on August 31, 2011, although the values assigned to the codes by CMS will not be available until the publication of the 2012 Medicare Physician Fee Schedule in November. The ACR communication lists five code pairs that have been identified as being performed together more than 75% of the time—and that are, therefore, under consideration for bundling in 2012:
• CT angiography of the abdomen and pelvis (74175 and 72191);
• renal angiography with radiological supervision and interpretation (36245–35248, 75722, and 75724);
• inferior vena cava filter placement and retrieval with radiological supervision and interpretation (37620 and 75940);
• abdominal paracentesis with imaging guidance (49080, 49081, 76942, and 77012); and
• sacroiliac-joint injections with radiological supervision and interpretation (27096 and 73542).