Neurosurgery Coding Alert

You’ll lose brain imaging code 78607 in 2020.

CPT^® 2020 will bring a lot of changes to your neurosurgery office. Not only will you see 23 electroencephalogram (EEG) updates, but you must also keep track of 18 injection, anesthetic, and steroid revisions; new spinal puncture codes; and several new T-code options.

Tackle These Injection, Anesthetic Agent, and Steroid Revisions

You will also see a plethora of revised codes for CPT^® 2020 that are going to impact your neurosurgery claims. They are as follows. (Emphasis added).

• 64400 (Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, any division or branch each branch (ie, ophthalmic, maxillary, mandibular))
• 64405 (Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve) and 64408 (Injection(s), anesthetic agent(s) and/or steroid; vagus nerve)
• 64415 (Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, single) through 64450 (Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch).

As you can see, all of the code descriptors above will get an “s” added to the word “injection.” Also, “agent” will become plural, and “and/or steroid will be added.” This change adds specificity to the code by letting you know that they apply to one or more injections using either anesthetic agents, and/or a steroid, says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

Also, the code descriptor for 64400 will see other changes, as well. For example, “any division or branch,” will be deleted. And, “each branch (ie, ophthalmic, maxillary, mandibular)” will be added. This change also clarifies that injection of each branch of the trigeminal nerve will be separately reportable, Przybylski explains.

Discover Brain and CSF Imaging Deletions

Deletions: CPT^® 2020 will also delete several codes you may use in your neurosurgery practice. You will say goodbye to injection and anesthetic agent codes 64402, 64410, and 64413.

In place of these deleted codes, you should report 64999 (Unlisted procedure, nervous system) instead.

Deletions: Come Jan. 1, you will also lose brain imaging code 78607. To report this service, you should submit 78803 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); tomographic (SPECT)) instead.

You will also lose cerebrospinal (CSF) fluid flow SPECT imaging code 78647. Instead, you should report 78803. This is distinct from the procedure commonly referred to as a “shuntogram” to evaluate CSF flow through a shunt, which you should report with 78645 (Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation), according to Przybylski.

Don’t Overlook These Miscellaneous Additions

Spinal puncture: CPT^® 2020 will give you two new spinal puncture codes. They are as follows:

• 62328 (Spinal puncture, lumbar, diagnostic; with fluoroscopic or CT guidance)
• 62329 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter); with fluoroscopic or CT guidance).

Sacroiliac joint: You will also see these two new codes involving the sacroiliac joint:

• 64451 (Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography))
• 64625 (Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)).

Additions: In 2020, you’ll also see three new neurostimulation T-codes. They are as follows:

• 0587T (Percutaneous implantation or replacement of integrated single device neurostimulation system including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve)
• 0588T (Revision or removal of integrated single device neurostimulation system including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve)
• 0589T (Electronic analysis with simple programming of implanted integrated neurostimu­lation system (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, posterior tibial nerve, 1-3 parameters).

Category III codes: Category III codes (also known as “T-codes”) are temporary or tracking codes for emerging services. The primary purpose of these codes is to allow for data collection, which in turn provides information for evaluating the effectiveness of new technologies and the formation of public and private policy.

“The need for these codes [arose] due to the development of new technology,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania.