2021 Radiology Coding Update

February 21, 2021

In just the first 45 days of 2021, we have seen policy changes that include specific documentation requirements.  Below we outline two coding updates that will affect many radiology practices across the country.

CT Perfusion – Palmetto Coverage Policy

The Palmetto Coverage Policy on CT Perfusion, which became effective as of February 7, 2021 will affect Alabama, Georgia, North Carolina, South Carolina, Tennessee, West Virginia and Virginia. This is the first MAC policy of its kind and previously non-covered by many payers. CPT defines Code 0042T as a cerebral perfusion analysis using computed tomography with contrast administration, including post-processing of parametric maps with determination of cerebral blood flow, cerebral blood volume, and mean transit time. The only covered ICD-10 codes for this study can be seen below.  

It should be noted that the only condition covered is stroke/CVA/infarction with the following specificity requirements:

  • Infarction due to – thrombosis, embolism, occlusion or stenosis
  • Laterality and artery – left carotid, right middle cerebral, etc.

If stroke/CVA is not documented as the reason for the study and an infarction is not found, the case will not be sent back through the RFI since additional information will not impact coverage. However, the RFI will be returned if stroke/CVA is indicated and/or findings are positive for infarction and the documentation is lacking the required specificity.

MIPS Measure 145 – Fluoroscopy Exposure

An important MIPS change for 2021 occurred with Measure 145 for Fluoroscopy Exposure. Fluoroscopic guidance codes 77001, 77002, and 77003 have been added as eligible services for this measure.  Many practices may not have templates or macros set up to include the documentation requirements for these services.  Cases will be returned through the “Return for Information” (RFI) process for cases including fluoroscopic guidance when the required elements aren’t documented.  Requirements include:

  • Radiation Exposure Indices
    • Must include Type of exposure and Dosage
    • Example: PSD = 10 mGy


  • Exposure time and number of fluoroscopic images
    • Fluoroscopy time was X sec/min.  Total # of films was xx.
    • Fluoro Time: XX; No images

Visit the resources section of the Zotec Partners website for more coding updates like these that impact your radiology business.   

By: Stacey Hall, Senior Director, Corporate Coding | February 19, 2021

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