Neurosurgery Coding Alert

Remember to check with payer to see if procedure’s covered.

If CPT^® 2024 is any indication, there could be a bevy of neurosurgery-specific CPT^® Category I codes coming in the next few years.

Why? There are quite a few new codes in the Category III section of CPT^® 2024, meaning CPT^® is looking at adding these codes to the permanent roster of codes.

Check out this rundown of new Category III (or T) codes that will be available for use on Jan. 1, 2024.

Know Category III Code Uses

According to the AMA, “CPT^® Category III codes are a set of temporary codes that allow data collection for emerging technologies, services, procedures, and service paradigms. These codes are intended to be used for data collection to substantiate widespread usage or to provide documentation for the Food and Drug Administration (FDA) approval process.”

Remember: Category III codes aren’t always reimbursable. Payment is determined by case and by payer. Basically, these codes have been created to establish usage so that in the future a Category I code might be created. Reach out to the payer to see if it reimburses the code.

Here’s the New T Codes for 2024

The list of new Category III/T codes for 2024 that you’ll want to note are listed below:

• 0784T (Insertion or replacement of percutaneous electrode array, spinal, with integrated neurostimulator, including imaging guidance, when performed)
• 0785T (Revision or removal of neurostimulator electrode array, spinal, with integrated neurostimulator)
• 0786T (Insertion or replacement of percutaneous electrode array, sacral, with integrated neurostimulator, including imaging guidance, when performed)
• 0787T (Revision or removal of neurostimulator electrode array, sacral, with integrated neurostimulator)
• 0788T (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, spinal cord or sacral nerve, 1-3 parameters)
• 0789T (Electronic analysis with complex 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, spinal cord or sacral nerve, 4 or more parameters)
• 0790T (Revision (eg, augmentation, division of tether), replacement, or removal of thoracolumbar or lumbar vertebral body tethering, including thoracoscopy, when performed)
• 0865T (Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR) study(ies), including lesion identification, characterization, and quantification, with brain volume(s) quantification and/or severity score, when performed, data preparation and transmission, interpretation and report, obtained without diagnostic MRI examination of the brain during the same session)
• 0866T (Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR) study(ies), including lesion detection, characterization, and quantification, with brain volume(s) quantification and/or severity score, when performed, data preparation and transmission, interpretation and report, obtained with diagnostic MRI examination of the brain (List separately in addition to code for primary procedure))

Comment: “It is important to understand that Category III codes are sometimes reimbursed by payers, and some Category I codes are not,” explains Gregory Przybylski, MD, Chairman of Neuroscience at the New Jersey Neuroscience Institute, JFK University Medical Center in Edison, New Jersey. “Category III codes are often created when the criteria for requesting a Category I code have not been met, but some information has been published about the procedure and there is enough anticipated usage that the service should be tracked.”