Eli's Rehab Report

Published on Mon Jun 28, 2004 PDF

Category III codes replace unlisted-procedure code

July 1, 2004, has come and gone, which means you should be reporting intradiscal electrothermal annuloplasty (IDEA) with one of two new Category III CPT Codes : 0062T (Percutaneous intradiscal annuloplasty, any method, unilateral or bilateral including fluoroscopic guidance; single level) or +0063T (... one or more additional levels [list separately in addition to 0062T for primary procedure]). This replaces the old way of reporting the unlisted-procedure code (64999, Unlisted procedure, nervous system).

"T" codes represent emerging technology, services, and procedures. They may evolve into a Category I code, depending on usage, clinical efficacy, and FDA approval. After five years, the codes either graduate to Category I or receive approval to continue their status as information collectors in Category III.

Don't Want to Use 'T' Codes? Too Bad

Rule: "If a Category III code exists for your procedure, you must use it," says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver. "You may not revert back to an unlisted-procedure code unless a private payer instructs you to do so."

For CT or MRI guidance and localization for needle placement and annuloplasty in conjunction with these new codes, see 76360 (Computed tomography guidance for needle placement [e.g., biopsy ...], radiological supervision and interpretation) and 76393 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device], radiological supervision and interpretation).

Remember: Codes 0062T/0063T do not carry a relative value unit rating. Individual payers (rather than the yearly fee schedule) determine reimbursement (and coverage) for these procedures. Because many payers still consider IDEA an experimental procedure, you may not receive any payment. Nonetheless, correct coding principles dictate that you report the procedure.