Anesthesia Coding Alert

Be cautious coding intradiscal annuloplasty with 0062T

Your natural instinct might be to leave Category III codes alone because, just like with unlisted procedures, you face reimbursement woes. But if you stick only with the tried-and-true Category I codes, you're risking noncompliance and cheating your providers out of potential future coverage.

The CPT section guidelines mandate the use of a Category III code if one is available that describes your physician's service, rather than using an unlisted Category I code.

Heads up: Category III codes may not necessarily conform to the usual CPT code requirements where FDA approval must have been received. The equipment, drugs, or both associated with Category III procedures don't absolutely have to be FDA-approved, says Joanne Mehmert, CPC, CCS-P, an independent consultant and owner of her own firm. However, such equipment or drugs may be in the process of FDA approval, Mehmert adds.

Choose a Pain Management Code for Max Benefit

There are a few Category III codes that apply to pain management:

• 0027T -- Endoscopic lysis of epidural adhesions with direct visualization using mechanical means (e.g. spinal endoscopic catheter system) or solution injection (e.g., normal saline) including radiologic localization and epidurography
• 0062T -- Percutaneous intradiscal annuloplasty, any method except electrothermal, unilateral or bilateral including fluoroscopic guidance; single level
• +0063T -- . . .  one or more additional levels (list separately in addition to 0062T for primary procedure).

Watch out on IDET: Following 2007 CPT revisions, neither 0062T nor +0063T include electrothermal procedures. A CPT parenthetical note directs coders for intradiscal electrothermal annuloplasty (IDET) procedures to look to Category I codes 22526 (Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level) and +22527 (. . . one or more additional levels [list separately in addition to code for primary procedure]).

Remember: Just like Category I IDET codes, the Category III percutaneous intradiscal annuloplasty code descriptions include fluoroscopic guidance.
 
Plan Now for Reimbursement Later

CPT instructions are clear on the use of Category III codes: report them whenever available. Because coverage and reimbursement remains a payer decision, you should follow the same process with reporting Category III codes as you do with unlisted Category I codes.  With Category III codes, you're not only following the instructions provided by CPT, but you're paving the way toward a potential Category I code in the future.

Some payers kick in: Stay current on your carriers' rules regarding Category III codes, and go ahead and submit claims with supporting documentation.

Consider Turning a Procedure Into a Code

CPT, of course, undergoes near-constant revision. It may be that your anesthesiologist or pain management specialist has performed a procedure or used a new technology that Category III codes don't yet cover. In this case, it might be time to propose a new code.

New codes in the Category III section are released semi-annually via the AMA-CPT Internet site so they're available faster.

Those codes released on January 1 are implemented on July 1, and likewise Category III codes released on July 1 are implemented on the following January 1. The full set of temporary codes for emerging technology, services, and procedures is published annually in the CPT code book.

"You can get a lot of information off of the AMA Web site on asking for revision of a code or how to get a new CPT code," Mehmert says. Be aware, however, that the process for getting a new CPT code on the books can take up to five years.

It is usually best to lobby for a new CPT code through your specialty's organization -- such as the American Society of Anesthesiologists or the American Society of Interventional Pain Physicians -- which will then promote your request to the AMA.