Ask Dr. Z

In your 2017 and 2018 Diagnostic Radiology Coding Reference books, the instruction was that if an axial and appendicular imaging were performed, to only report the axial CPT 77080. In the 2019 and 2020 books, the instruction has changed to "If axial and appendicular imaging are both performed, report both procedures, appending modifier -59 or -XS to the appendicular skeleton code." When did that guideline change and do you have resources that support that change? Did the RVUs change, as it was my understanding that the RVU for 77081 was included in 77080 if both were performed. Also, the wording in the NCCI manuals has not changed for these edits. Previous examples cited from the Clinical Examples in Radiology published by the AMA and ACR state that they are not to be coded together, but I have not seen any update on that since 2011 or 2012 guidelines. Can you provide more information on this change please?