Orthopedic Coding Alert

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

If CPT^® 2024 is any indication, orthopedic coders could be in for an influx of orthopedic-specific CPT^® Category I codes coming in the next few years.

The reason: There are quite a few new codes in the Category III (or T) codes section of CPT^® 2024, meaning CPT^® is looking at adding these codes to the permanent roster of codes.

For more information, check out this list of orthopedic-relevant Category III codes that will be available for use on Jan. 1, 2024.

Know How Category III Codes Are Used

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.

Check Out 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)

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.”