Anesthesia Coding Alert

Code +0777T is for use of an epidural guidance system. In that context, the names that you may see for 62320-62327 procedures include epidural or epidural steroid injection (ESI), says Doris V. Branker, CHC, CPC, CIRCC, CPMA, CPC-I, CANPC, CEMC, president of DB Healthcare Consulting and Education LLC in Sunrise, Florida.

ESI is a therapy option for chronic pain. You may see the anatomic site of the spine referenced as well, such as CESI (cervical), TESI (thoracic), or LESI (lumbar), Branker says.

Keep in mind: People often think of labor and delivery anesthesia when they hear the term epidural. But don’t make that assumption about 62320-62327. “The codes are typically not reportable in the labor scenario when it is the method of anesthesia for delivery, but you could see it in the acute pain area when done for post-op pain purposes,” Branker says. CPT^® provides codes like 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery …) for labor and delivery anesthesia.

Step 2: Understand When +0777T Is Appropriate

New code +0777T is an add-on code. According to a note with the code, you must report it in conjunction with a primary service code from 62320-62327. You can see the code and its accompanying parenthetical note at www.ama-assn.org/system/ files/cpt-category3-codes-long-descriptors.pdf.

You will report +0777T when the anesthesia provider uses a device that detects pressure changes during the 62320-62327 epidural injection service. The device helps identify and confirm the epidural space in real time. The guidance system reduces the risk of dural tears (tearing of the connective tissue layer that surrounds the spinal cord) and helps the provider perform the epidural procedure with fewer attempts.

Picture this: You can think of the epidural space “like a bag with a water balloon inside it, and inside the water balloon there are strings (nerves),” Branker says. “An epidural is going through the bag (ligamentum flavum) and washing the outside of the balloon by dumping solution in the space between the bag and balloon without puncturing it.”

For coding purposes, the 6XXXX code “is used for both the epidural and spinal injection technique (puncturing through the balloon),” Branker says. But remember that +0777T is specific to an epidural guidance system.

Step 3: Don’t Forget the Little Things That Add Accuracy

Coding is all about the details, so be sure to remember these tips as you complete your claims.

Confirm the approach: “Do not expect to see this [guidance system] technology for the transforaminal approach since the targeted structure is out of the way,” Branker says. The allowed primary “code range [62320-62327] is for the interlaminar approach. Transforaminal epidurals are captured with CPT^® codes 64479-+64484.”

Interlaminar means between the laminae of the vertebrae. The laminae are plates that form the roof of the spinal canal, providing support and protection for the backside of the spinal cord. In contrast, transforaminal means passing through the foramen, the hollow archway created by small bits of bone (pedicles) of adjacent vertebrae, creating a passageway that spinal nerve roots run through.

Focus on the technology: Category III codes are “temporary codes for emerging technology, services, procedures, and service paradigms,” CPT^® guidelines state. An example of a system you may see related to +0777T is EPI Detection®, Branker says. “That key term should help direct coders to the Category III code.”

Use the Category III code: As a Category III code, +0777T “is carrier-priced, so reimbursement, if any, will be discretionary,” Branker says. Although coverage and payment for +0777T is not guaranteed, you should not try to get around that by using an unlisted code or other Category I code. “If a Category III code is available, this code must be reported instead of a Category I unlisted code,” CPT^® guidelines state.

The reason is that “data collected from Category III codes is crucial to establishing Category I codes,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner of Pinnacle Enterprise Risk Consulting Services.

Category III codes are “temporary codes for emerging technology, services, procedures, and service paradigms,” CPT^® guidelines state. When you use the Category III code, you help show that providers are using the new service or procedure, which can help support changing the Category III code to a more permanent Category I code.

Note: Watch for an upcoming article on 2023 Category III codes 0771T-0774T for virtual reality procedural dissociation.