By G.J. Verhovshek, MA, CPC
Although you may not get reimbursed for these codes,correctly reporting them is the right thing to do.
For 2013, CPT® includes a total of 47 changes to Category III codes. Here’s a rundown to keep you up-to-date in the new year.
Category III Codes Are Important
Category III (temporary) codes often aren’t reimbursed by insurers, and aren’t assigned relative values in the Medicare physician fee schedule. So why bother reporting them? For two reasons:
- Because CPT® says so. Per American Medical Association guidelines, if a Category III code is available to describe a procedure or service, you must report it instead of a Category I unlisted procedure code.
- Because it’s the right thing to do. Reporting Category III codes allows tracking of emerging technologies, which often leads to the establishment of Category I codes (which generally do pay).
Not every Category III code will make the transition, however; if a Category III code is not replaced by a Category I code (or otherwise revised) within five years, the Category III code will “sunset,” unless there is a demonstrated need to continue the temporary code.
Revisions Aim for Greater Clarity
Just three Category III codes have been revised for 2013. In each case, the revisions were made to provide greater clarity on how or when to apply the code.
Category III codes 0195T Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without instrumentation, with image guidance, includes bone graft when performed; L5-S1 interspace and +0196T Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without instrumentation, with image guidance, includes bone graft when performed; L4-L5 interspace (List separately in addition to code for primary procedure) were revised to specify “without instrumentation,” to distinguish them from new code 22586 Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace.
0206T Computerized database analysis of multiple cycles of digitized cardiac electrical data from two or more ECG leads, including transmission to a remote center, application of multiple nonlinear mathematical transformations, with coronary artery obstruction severity assessment is revised to clarify that the procedure is performed for coronary artery obstruction severity assessment, but is not intended for cardiac ischemia.
Deletions Mostly Matched by Category I Additions
Sixteen Category III codes were deleted this year. In all but two cases, new Category I codes replace the deleted codes: Reporting of antiprothrombin antibody has reverted back to Category I unlisted procedure code 86849 Unlisted immunology procedure, while add-on 0173T for monitoring of intraocular pressure during vitrectomy surgery has been deleted without replacement.
Codes 0048T and 0050T have been deleted and replaced with 33990-33993 for insertion, removal, and repositioning of percutaneous ventricle assist devices, which are used during high-risk procedures or for critically ill patients.
Codes 0250T-0252T give way to 31647-31649 for insertion and removal for bronchial valves. The valves are inserted to treat patients with emphysema or lung damage to limit airflow to the damaged part of the lung to promote healing.
Use new codes 33361-33369 instead of Category III codes to report transcatheter aortic valve replacement (TAVR), a non-invasive procedure that replaces the aortic valve for patients with aortic stenosis (narrowing of the aortic valve).
Also new are 31660 and 31661 (replacing 0276T and 0277T) for bronchial thermoplasty, which uses radiofrequency ablation to treat asthmatic patients by reducing the muscle associated with airway constriction.
See Chart A for a summary of all Category III code deletions, with replacement codes:
||Ventricular assist device
||Ventricular assist device
||N/A (code has sunset)
||Intraocular pressure monitoring
||GI transit/pressure measurement
||Bronchoscopy for bronchial valve(s)
||33365 + 0318T
||33365 + 33366
||Bronchoscopy for bronchial thermoplasty
||Cell enumeration/testing for tumor cells
Additions Showcase Emerging Techniques, Technologies
Brand new for 2013, add-on Category III codes describe intravascular optical coherence tomography to gather microstructural information on atherosclerotic plaques. Code +0291T describes the initial vessel, while +0292T describes each additional vessel. Both codes include imaging supervision, interpretation, and report, as well as conscious sedation, when provided. The codes are reported in addition to the primary cardiac catheterization (92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, 93454-93461, 93563, 93564).
Codes +0293T and +0294T describes insertion of a device to monitor left atrial pressure to identify pressure changes in patients with heart failure, or a similar procedure performed during insertion of a pacing cardioverter-defibrillator, respectively. Both include conscious sedation, when provided, and should be reported in addition to 33230, 33231, 33240, 33249, or 33262-33264, but not 93462 or 93662.
New codes describe external electrocardiographic recording for more than 48 hours, up to 21 days. Current codes (93224-93227) report similar recording when performed up to 48 hours. Combination code 0295T describes all of the components (recording, scanning analysis with report, review, and interpretation). Codes 0296T-0298T report the component services separately. Report code 0296T for recording only, 0297T for scanning analysis with report only, and 0298T for review and interpretation only.
Extracorporeal shock wave treatment (ESWT), now reported with 0299T and +0300T, has been shown in the clinical setting to promote the healing of burns and other difficult-to-heal wounds. Claim 0299T for the initial wound and +0300T for each additional wound.
There are also new codes to describe procedures related to intracardiac ischemic monitoring devices. The system detects and warns of a major ischemic coronary event (e.g., coronary plaque rupture). New codes report insertion of the complete system (which includes a generator, adaptor, and transvenous lead), insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. All procedures include conscious sedation, when provided.
- Report 0302T when the entire system is inserted or replaced; 0303T when the only electrode is inserted or replaced, and 0304T when the device is inserted or replaced. All three procedures include interrogation and programming.
- Report 0305T for programming and adjustments of the system, including analysis, review, and report; or 0306T for interrogation of the system, including analysis, review, and report. Both services must be performed in person.
- Report 0307T when the device is removed without replacement.
A new subset of six Category III codes also now describes procedures related to vagal nerve blocking, which employs a device (consisting of a neurostimulator electrode array and pulse generator) to block hunger and satiety signals from the vagus nerve and does not alter the anatomy of the stomach:
0312T Laparoscopic implantation of the neurostimulator electrode array, pulse generator, and programming
0313T Laparoscopic revision or replacement of the electrode array, and connection to an existing pulse generator
0314T Laparoscopic removal of the electrode array and pulse generator
0315T Removal of the pulse generator only
0316T Replacement of the pulse generator only
0317T Electronic analysis and reprogramming of the pulse generator
Here is a summary of the remaining new Category III codes:
0301T Focused microwave thermotherapy of the breast for breast carcinoma
+0308T Insertion of ocular telescope prosthesis for central vision loss
+0309T Pre-sacral interbody technique L4-L5 arthrodesis with posterior instrumentation
0310T Motor function mapping prior to brain surgery
0311T Central arterial pressure waveforms to evaluate difficult-to-treat hypertension
0318T Implantation of a prosthetic aortic heart valve by open thoracic approach
G.J. Verhovshek, MA, CPC, is managing editor at AAPC.
January 1st, 2013
The Centers for Medicare & Medicaid Services (CMS) now covers transcatheter aortic valve replacement (TAVR) for Medicare patients, under certain conditions.
According to CMS, coverage for TAVR is approved under Coverage with Evidence Development (CED) only for the treatment of severe symptomatic aortic valve stenosis when all of the following five conditions are met:
- The procedure is furnished with a complete aortic valve and implantation system that has received FDA premarket approval for that system’s FDA-approved indication.
- Two cardiac surgeons have independently examined the patient face-to-face and evaluated the patient’s suitability for open aortic valve replacement (AVR) surgery; and both surgeons have documented the rationale for their clinical judgment and the rationale is available to the heart team.
- The patient (preoperatively and postoperatively) is under the care of a heart team: a cohesive, multi-disciplinary, team of medical professionals. The heart team concept embodies collaboration and dedication across medical specialties to offer optimal patient-centered care. TAVR must be furnished in a hospital with an appropriate infrastructure as specified in the decision memo.
- The heart team’s interventional cardiologist(s) and cardiac surgeon(s) must jointly participate in the intra-operative technical aspects of TAVR.
- The heart team and hospital are participating in a prospective, national, audited registry that: 1) consecutively enrolls TAVR patients; 2) accepts all manufactured devices; 3) follows the patient for at least one year; and 4) complies with relevant regulations relating to protecting human research subjects, including 45 CFR Part 46 and 21 CFR Parts 50 and 56.
The following outcomes must be tracked by the registry; and the registry must be designed to permit identification and analysis of patient, practitioner and facility level variables that predict each of these outcomes:
- All cause mortality
- Transient Ischemic Attacks (TIAs)
- Major vascular events
- Acute kidney injury
- Repeat aortic valve procedures
- Quality of Life (QoL)
See the decision memo for further specifications about the registry requirements.
CMS is requesting public comments, specifically about the use of CED, on the proposed determination pursuant to section 1862(l) of the Social Security Act. After considering the public comments, CMS will make a final determination and issue a final decision memorandum.
You can read the tracking sheet, proposed decision memo, decision memo, and view public comments documents on the CMS website.
May 11th, 2012