Orthopedic Coding Alert

CPT® 2016 will revise fluoroscopic guidance instructions and also introduce new codes.

The CPT^® Editorial Panel has announced what changes you can anticipate in 2016. While you won’t find many orthopedic changes, the epidural code revisions and updates may impact your orthopedic practice.

According to published notes from the Panel’s latest meeting in May, the group took three actions regarding epidural injection codes:

• Accepted revision, deletion, and renumbering of codes 62310-62319 that preclude imaging
• Accepted revision of fluoroscopic guidance instructions related to these injections 
• Added four new epidural injection codes that will include imaging.

The actual revisions to the existing codes have just been published. Current descriptors are:

• 62310 – Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic
• 62311 – … lumbar or sacral (caudal)
• 62318 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic
• 62319 – … lumbar or sacral (caudal).

Remember: Codes that contain an ‘X’ (e.g., 1002X4, 234X2X, 0301XT) are placeholder codes that are intended, through the first three digits, to give readers an idea of the proposed placement in the code set of the potential code changes. These codes are not used for claims reporting and will be removed and not retained when the final CPT^® Datafiles are distributed on August 31 of each year. To report the services for “X” codes, you should refer to the actual codes as they appear in the CPT^® Datafiles publication distributed on August 31 each year.

“Not everyone uses the Datafiles to access the new codes,” points out Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. “Of course, the changes will also be published in the 2016 CPT^® book.”

Don’t Miss the Latest on Other Proposed Changes

The Panel also accepted a proposed revision to the instructions to paravertebral facet joint nerve destruction codes to clarify the appropriate reporting. The affected codes are:

• 64633 – Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint 
• 64634 – … cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure)
• 64635 – … lumbar or sacral, single facet joint
• 64636 – … lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure).

Current guidelines for these codes direct you to report bilateral procedures with modifier 50 (Bilateral procedure). Each code also includes a note regarding procedures you may or may not report together. For example, you should not report 64633-64636 in conjunction with 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid]) or 77012 (Computed tomography guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], radiological supervision and interpretation). The updated instructions have been released this Fall.

“This continues the trend to bundle image guidance into interventional procedures in which image guidance is inherent in order to effectively perform the service,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Proposed changes to sphenopalatine ganglion sympathetic nerve block (64505, Injection, anesthetic agent; sphenopalatine ganglion) and hypoglossal nerve stimulator procedures (64868, Anastomosis; facial-hypoglossal) were withdrawn from the Panel’s consideration.

Get Ready to Welcome New and Revised Prolonged Services Codes Next Year

You also have relatively few E/M code changes, and we’ve got the details you need to know. Read on to learn the options you’ll have in the new year for reporting the above and beyond time your providers and staff spend with patients.

CPT^® 2016 will debut two add-on E/M codes to help you capture work your clinical staff performs after your physician sees the patient for an E/M service. You will be able to report 99415 (Prolonged clinical staff service [the service beyond the typical service time] during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour [List separately in addition to code for outpatient Evaluation and Management service]) and 99416 (…each additional 30 minutes [List separately in addition to code for prolonged services]) to seek additional, deserved reimbursement.

“Now here is a set of codes to really sink your teeth into; we hope!” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, director of PB Central Coding at Allegheny Health Network in Pittsburgh, Pa. “Often times a physician’s time with the patient only paints a partial picture of what occurred during the visit. It could have been that the staff was asked to give an injection, but the patient was uncooperative. It might include education for a new medication, therapy, or options for care that go far beyond the time illustrated in the E/M code, but, that education doesn’t have to be that of the physician. The staff [members] in a physician’s office are important to the care of the patient and also are an expense to the physician. These codes make good sense all around to be included in the new code sets. This may also come into play with the trend of coverage for more preventive services. I am anxious to see how these codes play out in policy and, if reimbursable, what might that reimbursement look like.”