Anesthesia Coding Alert

Know how to count time for these high-tech CPT^® 2023 codes.

If your anesthesia practice is exploring virtual reality (VR) options for decreasing patients’ pain, there are four 2023 Category III codes you need to know. Here’s a quick Q&A to help you understand the new VR procedural dissociation codes and the extensive guidelines that accompany them in the CPT^® 2023 code set.

Which Codes Apply to VR Procedural Dissociation?

The new codes for VR procedural dissociation services, effective Jan. 1, 2023, are 0771T-+0774T. You will choose between the codes based on who performs the service.

The first two codes apply when a single provider performs both the VR service and the diagnostic or therapeutic service performed at the same session. An independent observer must be present for these VR codes to be appropriate. The guidelines state that the observer must be qualified to monitor the patient, be trained in immersive technology, be able to adjust the tech under provider supervision, and not have other duties during the procedure.

• 0771T (Virtual reality (VR) procedural dissociation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports, requiring the presence of an independent, trained observer to assist in the monitoring of the patient’s level of dissociation or consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older)
• +0772T (… each additional 15 minutes intraservice time (List separately in addition to code for primary service))

The other two codes apply to the VR service when one provider performs the VR service, and another performs the related diagnostic or therapeutic service.

• 0773T (Virtual reality (VR) procedural dissociation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports; initial 15 minutes of intraservice time, patient age 5 years or older)
• +0774T (… each additional 15 minutes intraservice time (List separately in addition to code for primary service))

“This is still a developing area,” says Doris V. Branker, CHC, CPC, CIRCC, CPMA, CPC-I, CANPC, CEMC, president of DB Healthcare Consulting and Education LLC in Sunrise, Florida. “The AMA needs some additional feedback to make a decision on this technology, which is why this is a Category III code currently.”

Remember: Category III codes are “temporary codes for emerging technology, services, procedures, and service paradigms,” CPT^® guidelines state. “If a Category III code is available, this code must be reported instead of a Category I unlisted code.”

“Reporting the Category III codes provides the data for clinical usage that could impact conversion to a Category I code and future payment,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, revenue cycle director for Clinical Health Network for Transformation in Houston, Texas. You can find these new codes and guidelines online at www.ama-assn.org/system/files/cpt-category3-codes-long-descriptors.pdf.

What Is VR Procedural Dissociation?

Generally speaking, VR is a simulated environment that lets people interact with virtual surroundings. Users typically wear a headset. For the new codes, the VR involves “a computer-generated audio, visual, and proprioceptive immersive environment,” the guidelines state. Proprioception is the body’s ability to sense movement, action, and location.

These new codes are specific to a state of altered consciousness that improves patient comfort and tolerance for the procedure while decreasing the patient’s pain, the guidelines state. Patients can still respond to spoken instructions and stimuli.

As an example, you may see these services during interventional radiology procedures, such as thyroid biopsies and vascular access procedures (www.researchgate.net/publication/361375836_Virtual_Reality_and_its_Effect_on_the_Reduction_of_Pain_During_Interventional_Radiology_Procedures). Specialty societies including the American College of Radiology and Society of Interventional Radiology sponsored these codes.

What Services Are Part of VR Procedural Dissociation?

Along with the use of VR, the new codes require monitoring patient response. The provider is responsible for periodically assessing the patient, checking how well they are tolerating the procedure, and also monitoring oxygen saturation, heart rate, pain, neurological status, and global anxiety, the guidelines state.

The codes also require changing the VR program to optimize the patient’s state. The guidelines provide examples of optimization techniques, such as changing the software program, adjusting the volume or visual environment, making changes necessary to reposition the patient, changing programming to maintain the dissociated state, and using a feedback loop to achieve the desired dissociated state level.

“Our pediatric anesthesia providers are sometimes asked to do this service,” says Branker. But note that the codes apply only to patients 5 years of age and older.

What Is Not Part of VR Procedural Dissociation?

The guidelines make it clear that VR procedural dissociation is distinct from the services represented by the Anesthesia section of CPT^®. These new codes do not include interventions to maintain:

• Cardiovascular function
• Patent (open) airway
• Spontaneous ventilation (breathing)

You also should not use the new codes to report administering medication for:

• Pain control
• Anxiolysis (minimal sedation)
• Moderate sedation
• Deep sedation
• Monitored anesthesia care (MAC)

Important: “Time spent administering VR procedural dissociation cannot be used to report moderate sedation or anesthesia services,” guidelines state.

What Is Intraservice Time for 0771T to +0774T?

The new VR codes are time-based, so you must know what to include in calculating the time. The descriptors refer to intraservice time, which the guidelines define as follows:

• Begins with administration of VR technology
• Requires continuous face-to-face provider attendance (don’t add face-to-face time that occurs after the continuous time ends)
• Ends when the procedure and VR administration end and face-to-face time is over

You should not report the pre- and post-service work and time separately. That means you should not count or report the time for ordering and selecting the VR program, explaining the service to the patient or caregiver, applying the VR device, or anything that occurs after intraservice time ends.

Does 15 Minutes Really Mean 15 Minutes?

Codes 0771T and 0773T each apply to the “initial 15 minutes” and add-on codes +0772T and +0774T apply to “each additional 15 minutes.” But a table in the guidelines with these codes clarifies that the time thresholds are roughly the halfway point of those 15 minutes.

• Use the initial codes for 10-22 minutes. Don’t separately report VR services lasting fewer than 10 minutes.
• Report the initial code and one unit of the add-on code once you hit 23 minutes. That’s 15 minutes (initial code) and eight minutes (add-on code) to reach the total of 23 minutes.
• Add another unit of the add-on code each time you reach eight minutes past the time represented by the previous code, such as 2 units of the add-on code for 38 minutes (15 minutes + 15 minutes + 8 minutes).