Neurosurgery Coding Alert

Choose category III code over unlisted-procedure code

July 1 has come and gone - which means you should be reporting intradiscal electrothermal annuloplasty (IDEA) with one of two new category III CPT codes: 0062T (Percutaneous intradiscal annuloplasty, any method, unilateral or bilateral including fluoroscopic guidance; single level) or +0063T (... one or more additional levels [list separately in addition to 0062T for primary procedure]). These codes replace unlisted- procedure code 64999 (Unlisted procedure, nervous system), which practices previously used to report IDEA.

"T" codes describe emerging technology, services and procedures. They may evolve into a Category I (regular CPT) code, depending on use, clinical efficacy and FDA approval. After five years, the codes either graduate to category I, receive approval to continue their status as category III codes or are automatically deleted. 

Rule: "If a category III code exists for your procedure, you must use it," says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver. "You may not revert back to an unlisted code unless a private payer instructs you to do so."

For CT or MRI guidance and localization for needle placement and annuloplasty in conjunction with 0062T and 0063T, see 76360 (Computed tomography guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], radiological supervision and interpretation) and 76393 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device], radiological supervision and interpretation).

Remember: Codes 0062T and 0063T do not carry a relative value unit rating. Individual payers (rather than the yearly fee schedule) determine reimbursement (and coverage) for these procedures. Because many payers still consider IDEA an experimental procedure, you might not receive any payment. Even so, correct coding principles dictate that you report the procedure.