Radiology Coding Alert

Find out what this change means for 77003.

If you report guidance separately for transforaminal epidural injections in the new year, expect a denial. CPT 2011 revises the injection codes to include guidance. Here's what you need to know.

Stay tuned: We'll continue bringing you information on CPT 2011 changes for radiology in future issues.

Assuming Guidance Revisions Aren't Important Could Cost You CPT 2011 revises transforaminal epidural injection codes 64479-64484 to clarify that a single code may apply to one or more injections and, in even bigger news, to include fluoroscopy or CT imaging guidance. These changes take place in the portion of the definition that the codes share:

2010: Injection, anesthetic agent and/or steroid, transforaminal epidural ...

2011: Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT) ...

Watch out: CPT 2010 instructs you to report 77003 (see code definition below) with 64479-64484 to represent fluoroscopic guidance and localization for needle placement and injection. But the 2011 codes clearly include imaging guidance, meaning you should not report 77003 with the codes in 2011.

Expect this change: In addition to adding a note following 77003 to not report 77003 with 64479-+64484, CPT 2011 revises 77003's code definition, deleting reference to transforaminal epidural, paravertebral facet joint, and paravertebral facet joint nerve:

2010: Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint], including neurolytic agent destruction

2011: Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, subarachnoid, or sacroiliac joint), including neurolytic agent destruction.

Note: See the last section of this article for more information on coding paravertebral facet/ joint injections.

Flip to Category III Codes for Injection With US Guidance

Radiology coders should take note of codes 0228T-+0231T (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance ...), says Cheryl Schad, BA Ed, CPC, ACS-RA, PCS, president and CEO of Schad Medical Management in Mullica Hill, N.J. CPT implemented these codes on July 1, 2010, so they didn't make it into the 2010 manual. But you will see them in the 2011 manual:

• 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).

Key point: Codes 0228T-+0231T specify "ultrasound guidance" and include it, meaning you should not code that guidance separately, says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting & Coding Education, LLC.

See the chart, "64479-64484 and 0228T-+0231T Coding At-A-Glance," on page 91 to see how your coding options break down.

Codes 0213T-+0218T Finally Appear in the Manual

The changes to transforaminal epidural injection coding make those codes similar to the coding options for paravertebral facet joint/injection. Although CPT implemented codes 0213T-+0218T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance ...) Jan. 1, 2010, they didn't appear in the 2010 manual. You will see them in the 2011 manual:

• 0213T -- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level
• +0214T -- ... second level (List separately in addition to code for primary procedure)
• +0215T -- ... third and any additional level(s) (List separately in addition to code for primary procedure)
• 0216T -- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level
• +0217T -- ... second level (List separately in addition to code for primary procedure)
• +0218T -- ... third and any additional level(s) (List separately in addition to code for primary procedure).

Helpful: You can see Category III codes online throughout the year on the AMA's Web site (www.ama-assn.org). Under Physician Resources, choose "Solutions for Managing Your Practice." In the menu on the left, choose "Coding Billing Insurance," then "CPT," and finally "About CPT" to reach the page where you may download Category III codes. You'll find guidelines, as well as codes. For example, the notes for 0213T-+0218T indicate you should append modifier 50 (Bilateral procedure) for bilateral services. You're also instructed not to report +0215T and +0218T more than once per day.

Remember: For paravertebral facet joint/nerve injections with fluoroscopy or CT guidance, you should use 64490-+64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT] ...).