AMA Reveals 2004 CPT Category III Codes

Research-oriented codes replace unlisted category I's

You'll have to learn a handful of new codes that don't conform to the usual rules by the time Jan. 1 rolls around - and getting cozy with them now will ease your winter.
According to a July 1 American Medical Association (AMA) release, the CPT editorial panel proposed eight new category III CPT codes for emerging technology, services, and procedures that take effect at the beginning of next year.
The AMA assigns category III codes for periods of five years or less, and uses them to provide data for research on healthcare delivery and the formation of public and private policy. After five years, the codes either graduate to category I or receive approval to continue their status as information collectors in category III.
The Great Eight
The following category III codes start their temporary tenure on Jan. 1:
  0054T - Computer-assisted  musculoskeletal surgical navigational orthopedic procedure,   with image guidance based on   fluoroscopic images (list separately in addition to code for primary procedure)
  0055T - ... with image guidance based on CT and MRI  images (list separately in addition to code for primary proce -  dure)
  0056T - ... imageless (list    separately in addition to code for primary procedure)
  0057T - Upper gastrointestinal endoscopy, including  esophagus, stomach, and either  the duodenum and/or jejunum   as appropriate, with delivery of  thermal energy to the muscle of  lower esophageal sphincter and/or gastric cardia, for treat-  ment of gastroesophageal reflux  disease
  0058T - Cryopreservation;   reproductive tissue, ovarian
  0059T - ... oocyte(s) 
  0060T - Electrical impedance scan of the breast, bilateral (risk assessment device for breast cancer)
  0061T - Destruction/reduction of malignant breast tumor including breast carcinoma cells in the margins, microwave  phased array thermotherapy, disposable catheter with combined temperature monitoring   probe and microwave sensor, externally applied microwave energy, including interstitial placement of sensor.
The AMA stresses that you must use a category III code if one is available, even if you've been using a category I unlisted code for these services and procedures in the past.
Don't Fall for Unlisted Codes
If your facility performs any of these procedures regularly - particularly if you're a major research-focused hospital - your adjustment will be trickier, because you're already accustomed to using the category I unlisted codes for the same services. But that means learning the new codes is even more crucial at large research facilities.
Keep in mind that certain guidelines that govern category I codes - such as U.S. Food and Drug Administration approval, requirements that many healthcare professionals perform the service in myriad locations, and clinical safety, effectiveness, and applicability to clinical practice - do not apply to the category III codes because their sole purpose is information-gathering.


- Published on 2003-09-11