Neurosurgery Coding Alert

Code represents MRI/US combo.

CPT^® has released its list of new, revised, and deleted codes for 2025, and it contains several entries that will be relevant to your neurosurgeon.

Such as? An ablation technique that combines magnetic resonance imaging (MRI) with ultrasound (US) is getting a permanent CPT^® code. There are also several codes for thoracic fascial plane blocks that you’ll want to note.

Check out the changes you’ll want to note before CPT^® 2025 takes effect on January 1, 2025.

Use 61715 for MRI/US Combo

The first code you’ll want to note is 61715 (Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation of target, intracranial, including stereotactic navigation and frame placement, when performed.) This code will replace the current Category III code for this procedure, 0398T (Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when performed).

More on the treatment: Magnetic resonance imaging-guided high-intensity focused ultrasound could be referred to as MRgFUS or MRgHIFU in the notes. It is a treatment that uses MRI to provide images that allow the surgeon to visualize the target areas and monitor treatment. The treatment also uses high-intensity US to heat and destroy diseased tissue. MRgFUS induces thermal ablation, which can destroy target tissue with minimal damage to surrounding structures.

Example: A patient with an essential tremor is scheduled for MRgFUS. The patient lies on the MRI table and the patient’s head is aligned with the US device. Using MRI, the surgeon identifies the ventral intermedius nucleus. Then, they deliver US waves directly to the target to heat and destroy it.

When CPT^® 2025 is effective, you’ll report 61715 for the MRgFUS with G25.0 (Essential tremor) appended to represent the patient’s condition for which the treatment was performed.

Use New Codes for This Thoracic Block

CPT^® 2025 will also feature a new code set for thoracic fascial plane blocks. These regional blocks are used to control thoracic pain during surgery. During the block, the surgeon injects local anesthetic into fascial planes around the chest, blocking pain signals.

The codes for thoracic fascial plane block are:

• 64466 (Thoracic fascial plane block, unilateral; by injection(s), including imaging guidance, when performed)
• 64467 (… by continuous infusion(s), including imaging guidance, when performed)
• 64468 (Thoracic fascial plane block, bilateral; by injection(s), including imaging guidance, when performed)
• 64469 (… by continuous infusion(s), including imaging guidance, when performed)
• 64473 (Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance, when performed)
• 64474 (… by continuous infusion(s), including imaging guidance, when performed)

Remember Codes Are Resequenced

The new codes are out of sequence, so you won’t find them in the proper numeric location in CPT^® 2025. They are additions to another group of resequenced codes, which start after +64484 (Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure)) and end before 64486 (Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)).

Between those codes, the 2025 CPT^® book will list these resequenced codes:

• # Denotes resequenced code
• Denotes new code
• # 64461 (Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed))
• # +64462 (… second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure))
• # 64463 (… continuous infusion by catheter (includes imaging guidance, when performed))
• # 64466
• #  64467
• #  64468
• #  64469
• #  64473
• #  64474.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC