Transforaminal epidural injections have new codes you can't miss.
Does July 1 make it onto your list of new code implementation dates? It should. July brings announcements regarding new Category III codes. This July, be sure you catch new transforaminal epidural codes. Plus, get a sneak peak at what's coming in January.
Start Using New Transforaminal Choices
The AMA released four new transforaminal injection codes in January. They went into effect July 1, so update your systems accordingly:
0228T --
Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level
0229T -- ...
each additional level (List separately in addition to code for primary procedure)
0230T --
Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level
0231T -- ...
each additional level (List separately in addition to code for primary procedure).
The additions give coders specific choices for epidural steroid injections, says
Catherine Brink, BS, CPC, CMM, CMSCS, president of Healthcare Resource Management in Spring Lake, N.J.
Before filing your first claim with 0228T-0231T, however, pay attention to the associated parenthetical notes regarding techniques and guidance.
Different Technique Changes Codes
The new codes apply when the physician uses ultrasound guidance when administering transforaminal epidural injections. Other codes apply, however, when your radiologist opts for fluoroscopy or CT guidance. Notes with the new codes direct you to injection codes 64479-64484 (
Injection, anesthetic agent and/or steroid, transforaminal epidural ...) in those situations. You may report imaging guidance separately in addition to those codes.
Heed 'US Guidance Included' Rule
Because 0228T-0231T specify "with ultrasound guidance," you should not report additional codes for the guidance. Notes state you should not report the new transforaminal epidural codes with:
76942 --
Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation
76998 --
Ultrasonic guidance, intraoperative
76999 --
Unlisted ultrasound procedure (e.g., diagnostic, interventional).
Publication date: Codes 0228T-0231T became effective July 1, but you won't see them in the Category III code section of the CPT manual until the 2011 version.
Eye on the Future: Jan. Codes Announced
The AMA also has announced several codes that will be implemented Jan. 1, 2011.
If your practice performs endovascular repairs, be sure to check out the following codes going into effect in January:
0254T --
Endovascular repair of iliac artery bifurcation (e.g., aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using bifurcated endoprosthesis from the common iliac artery into both the external and internal iliac artery, unilateral
0255T -- ...
radiological supervision and interpretation.
The AMA also announced new codes for transluminal peripheral atherectomy that will include radiological supervision and interpretation:
0234T --
Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; renal artery
0235T -- ...
visceral artery (except renal), each vessel
0236T -- ...
abdominal aorta
0237T -- ...
brachiocephalic trunk and branches, each vessel
0238T -- ...
iliac artery, each vessel.
Remember the Rules of the Cat. III Code
CPT creates Category III codes for emerging technologies, services, or procedures that might not be widely performed.
Key point: CPT requires you to bill with the codes to track their use and effectiveness. If a technology (and therefore a code) becomes more widely used, it has the potential to become a Category I. "Codes in this section of the CPT may or may not eventually receive a Category I CPT code," says
Lisa Center, CPC, a billing professional with Mt. Carmel Regional Medical Center in Pittsburg, Kan.
CPT requires providers to report the code that accurately describes the services provided; i.e., providers must report the Category III code rather than reporting a CPT code that is "close" to the code listed, or reporting one of the unlisted CPT codes. "You must pick the Category III code for a particular service before using an unlisted Category I CPT code," Center says.
Bottom line: Even though Category III codes notoriously go unpaid, you must report a Category III code if it's the appropriate code for your service.
Resource: Because the AMA releases Category III codes in January and July, you may find a number of additions or deletions between published CPT manuals. Check the AMA website for updates and descriptions for all Category III codes:
www.ama-assn.org/ama1/pub/upload/mm/362/cptcat3codes.pdf.
