Neurology & Pain Management Coding Alert

New Category III codes bring much-needed specificity.

July brings announcements regarding new Category III codes, so prepare now for new transforaminal epidural codes just going into effect or that you'll use beginning Jan. 1, 2011. Start Using New Transforaminal Choices The American Medical Association (AMA) released four new transforaminal injection codes in January. They went into effect July 1, so update your systems accordingly:

• 0228T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level
• 0229T -- ... each additional level (List separately in addition to code for primary procedure)
• 0230T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level
• 0231T -- ... each additional level (List separately in addition to code for primary procedure).

The additions finally give coders specific choices for epidural steroid injections, says Catherine Brink, BS, CPC, CMM, CMSCS, president of Healthcare Resource Management, Inc., in Spring Lake, N.J. In the past, you resorted to submitting the best-fitting choice from 64479-64484 (Injection, anesthetic agent and/or steroid, transforaminal epidural ...) for the injection and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) for the ultrasound.

"Most chronic pain patients are referred to pain clinics now, instead of visiting a neurologist's office," points out Marianne Wink, RHIT, CPC, ACS-EM, a coder in Rochester, N.Y. Being aware of the new codes, however, comes in handy for patients who find their way to your practice.

Before filing your first claim with 0228T-0231T, however, pay attention to parenthetical notes about techniques and guidance associated with the code family.

Different Technique Changes Codes

The new codes apply when the physician uses ultrasound guidance when administering transforaminal epidural injections. Other codes apply, however, when your provider opts for fluoroscopy or CT guidance.

Notes direct you to injection codes 64479-64484 in those situations. Say 'No' to Radiology

Because 0228T-0231T specify "with ultrasound guidance," you won't need to bill additional radiology needle guidance codes for the service. Notes state you should not report the new transforaminal epidural codes with:

76942 -- Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation

76998 -- Ultrasonic guidance, intraoperative

76999 -- Unlisted ultrasound procedure (e.g., diagnostic, interventional).

Watch for 0228T-0231T in the Category III code section of CPT 2011.