Otolaryngology Coding Alert

Question: I am considering using 0088T for a radiofrequency treatment on the base of the tongue. Should I use the Category III code instead of a Category I unlisted-procedure code?


Massachusetts Subscriber

Answer: You must report the Category III code 0088T (Submucosal radiofrequency tissue volume reduction of tongue base, one or more sites, per session [i.e., for treatment of obstructive sleep apnea syndrome]), not the Category I unlisted-procedure code 41599 (Unlisted procedure, tongue, floor of mouth). "If a Category III code is available for a given service or procedure, use the Category III code instead of a Category I unlisted code," states CPT's "Category III Codes" introductory notes.

You should report 0088T on radiofrequency tongue reduction claims dated Jan. 1, 2005, and later. CPT 2005 introduced the temporary Category III code.

Category III codes describe emerging technologies, services and procedures. Physicians, payers and health policy experts use these codes to collect data. Based on the frequency of code use, the AMA may assign the procedure a permanent code.

CMS does not assign relative value units to Category III codes, so payment is not guaranteed. The same reimbursement rules also apply to unlisted-procedure codes. The 2005 Medicare Physician Fee Schedule doesn't cite prices for unlisted-procedure codes.

You may find that insurers deny 0088T for the same reason the companies rejected radiofrequency tongue reduction claims with 41599. Many payers consider the procedure investigational.

For instance, BlueCross BlueShield of Massachusetts does not cover treatment for "radiofrequency-volumetric tissue reduction of the tongue (sometimes known as Somnoplast or Coblation) for obstructive sleep apnea, upper airway resistance syndrome (UARS) or simple snoring, because there are no controlled trials comparing the efficacy to other treatments of sleep apnea." Therefore, all plans will reject 0088T "according to Medical Technology Assessment Guidelines," states BCBS of Massachusetts' "Sleep Disorders Diagnosis and Treatment" policy.

Best bet: Obtain preauthorization for tongue base radiofrequency reduction. Also, have the patient sign a waiver making him responsible for payment in the event of noncoverage.