Part 2: Know What’s New in CPT® 2020 for Radiology and Path/Lab

radiology CPT 2020 updates

You’ve gotten a glimpse at the new E/M and Surgery codes in Part 1 of our CPT® 2020 series. Now let’s dive in to the updates for the Radiology section and the Pathology and Laboratory section.

Focus on 4 Areas for Radiology Updates

Abdomen X-rays, GI imaging, myocardial imaging, and radiopharmaceutical tumor localization are the headliners for the radiology code updates.

Abdomen X-ray: In 2019, you have 74022 (Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest). In 2020, the descriptor will change to specify the code requires “2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest.”

GI X-ray: Many of the changes in the Radiology section will occur in the Gastrointestinal Tract subsection. Watch for updates adding scout radiographs and delayed images as well as options for double-contrast studies. Here are the specifics:

  • Pharynx/cervical esophagus code 74210 and swallowing study code 74230 will add that these are contrast studies and the codes include any scout neck radiographs and delayed images performed.
  • Esophagus code 74220 adds scout chest radiographs and delayed images. This code will be a single-contrast study, making room for new double-contrast study code 74221.
  • Upper GI and small intestine codes will see changes, too.
    • Upper GI code 74240 continues to apply to a single-contrast study, but now specifies it includes scout abdominal radiographs. Both the 2019 and 2020 descriptors include delayed images.
    • For a double-contrast study, you’ll use revised code 74246.
    • To make room for these changes, CPT® 2020 deletes several codes (74241, 74245, 74247, 74249) and adds small intestine follow-through code +74248 for use with 74240 and 74246.
    • The codes for small intestine exams with multiple serial images will also see revisions. Both 74250 and 74251 will include scout abdominal radiographs. You’ll use 74250 for a single-contrast study and 74251 for a double-contrast study.
  • The trend continues in colon codes 74270 and 74280, which will see revisions to include scout abdominal radiographs and delayed images. Use 74270 for a single-contrast study and 74280 for a double-contrast study.
  • We can’t include descriptors for all of the codes here (that’s what TCI SuperCoder is for!), but this example will offer an idea of how the new descriptors look: 74221 (Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study).

Myocardial imaging: Another large group of changes are connected to the myocardium, the thickest layer of the heart wall. CPT® 2020 brings these changes:

  • The descriptor for existing PET metabolic evaluation code 78459 will specify that the code includes ventricular wall motion and ejection fraction (EF) when performed. That code will also now specify it represents a single study. You’ll use new child code 78429 when a CT transmission scan is concurrently acquired. (In this case, child code means that 78459 and 78429 have the same descriptors before the semicolon, and 78429 adds the CT requirement after the semicolon.)
  • You’ll see similar changes for PET perfusion single-study code 78491, adding wall motion and EF if performed. A new child code, 78430, will be available when there is concurrently acquired CT. Child code 78492 for multiple studies is still available but will be revised to “multiple studies at rest and stress (exercise or pharmacologic)” instead of “multiple studies at rest and/or stress.” And you’ll have new child code 78431 for multiple studies with concurrent CT.
  • There also will be a new code for perfusion with metabolic evaluation with dual radiotracer, 78432. Use new code 78433 when the study has a concurrent CT.
  • Notes with the codes let you know that the CTs referenced in the descriptors must be for attenuation correction and anatomical localization.
  • When you report rest and stress perfusion study using 78431 or 78492, watch for the opportunity to report new add-on code +78434 for absolute quantitation of myocardial blood flow PET.

RP localization: You’ll have new and revised codes for “Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s).” The codes include but don’t require vascular flow and blood pool imaging.

  • Code 78800 will be revised to specify planar, single-area, single-day imaging. Code 78801 will change from a simple reference to multiple areas to apply to planar imaging of two or more areas for one or more days, or two or more days of single-area imaging. Whole body codes 78802 (single day) and 78804 (multiple days) will now specify planar.
  • SPECT code 78803 will add single-area, single-day imaging to the descriptor. And you’ll have three new SPECT codes, too. Use 78830 for single-area and single-day with concurrent CT. For at least two areas on one day or a single area on multiple days, use 78831. And choose 78832 for a 78831 service with concurrent CT.
  • You’ll also have a new add-on code for radiopharmaceutical (RP) quantification measurements to report alongside new SPECT with concurrent CT codes 78830 and 78832.

Pick Up New Codes for Chemistry, MoPath, MAAA

The code changes for the Pathology and Laboratory section of CPT® start with six new chemistry codes. You’ll have specific options for adalimumab, infliximab, lacosamide, posaconazole, vedolizumab, and voriconazole.

There will also be new molecular pathology and cytogenetics codes:

  • Code 81277 for cytogenomic neoplasia microarray analysis
  • New PALB2 gene analysis codes 81307 (full gene sequence) and 81308 (known familial variant)
  • Code 81309 for PIK3CA gene analysis.

For multianalyte assays with algorithmic analyses (MAAA), watch for these updates:

  • Code 81522 for breast oncology, mRNA, gene expression profiling
  • Code 81542 for prostate oncology, mRNA, microarray gene expression profiling
  • Code 81552 for uveal melanoma, mRNA, gene expression profiling.

Proprietary Lab Analyses (PLA) code 0081U will be deleted to make room for that last new code 81552. And speaking of PLA codes, the 2020 code set published in the book will include a long list of new PLA codes. We won’t cover those in this article, but keep in mind that many of the codes were implemented during 2019. So those particular ones may be new to the annually released book, but they won’t be new to you.

What About You?

All those CPT® 2020 code set changes are a lot to take in! Let us know which ones you’d like a closer look at. We’ll wrap up with the Medicine section in Part 3.


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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1 Comments For This Post

  1. vongphet somchanhmavong Says:

    Can you give example of when to charge for the new code 78835 Radiopharmaceutical quantification measurement?

    Any incite is greatly appreciated.

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