Radiology Coding Alert

Your fibroid ablation and sacroplasty coding will have more specificity with Category III codes that you can continue to use this year.

Caveat: You’ll need to choose a Category III code instead of a non-specific or unlisted procedure code, when one is available. This makes your claims more specific and sound. Be aware that Category III codes may not always get you payment, but you should not ignore these codes in your practice. Your provider may need to submit additional documents to support the service of Category III codes, depending on the payer’s instructions. These documents may include scientific evidence in literature to support the service.

Intent: “Category III codes are temporary codes for new and emerging technologies. They have been created to allow for data collection and utilization tracking for new procedures or services to determine whether new codes are needed,” says Michele Midkiff, CPC-I, RCC, an interventional and neuro-interventional radiology coding consultant in Mountain View, CA.

Look for Means of Fibroid Ablation

Advancement in technology has enabled non-invasive ablation of fibroid tissue. Your physician may use ultrasound to extirpate the fibroid tissues. To access the deeper targets, your physician may use MR guidance. When your physician uses radiofrequency to devascularize and shrink the fibroid, you may refer to the procedure as a HALT (Hysterectomy ALTernative) procedure. This is because use of this procedure helps to avoid invasive hysterectomy. You should check how much tissue did your physician actually ablate during this procedure.

Accordingly, you submit category III code 0071T (Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume less than 200 cc of tissue) for fibroid volume less than 200 cc and code 0072 T (Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume greater or equal to 200 cc of tissue) for fibroid volume of 200 cc or more.

Magnetic resonance imaging: Traditionally, leiomyomata lysis has been done laparoscopically. More recently, some physicians have done this procedure percutaneously using magnetic resonance imaging guidance. The MRI provides guidance for the insertion of the probe as well as thermal imaging maps.

Be aware: The MR image guidance is inclusive in category III codes 0071T and 0072T. Do not separately report the MR imaging with these codes.

Example: You can easily interpret the procedure note. You may read that your physician identified the fibroid(s) on MR images of the pelvic region in a patient who lay in prone position and was made to slide into a standard MRI scanner. Your physician will then use high energy focused ultrasound waves to heat a small spot in the uterine fibroid to high temperatures. This pulse or sonication may last only about 15 seconds. Your physician will then monitor the progress and will review temperature-sensitive images. Your physician will repeat the sonication and the entire procedure may last a few hours depending upon the number and size of fibroids treated. This procedure provides real time feedback about temperature changes of the treated fibroid. Your physician can determine how much the fibrotic tissue has been successfully ablated (destroyed).

Why MR guidance? The MR images help your physician to identify where the fibroid is and what portion has been treated. This is non-invasive.

Include Imaging Guidance and Biopsy in Sacroplasty Codes

When reporting sacroplasty, you need to confirm if your physician provided injections on one or both sides. Accordingly, you will choose from the following two codes:

• 0200T (Percutaneous sacral augmentation [sacroplasty], unilateral injection[s], including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed)
  
• 0201T (Percutaneous sacral augmentation [sacroplasty], bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed)

What is new in 2015? Effective January 1, 2015, you have seen revisions in the descriptor for 0200T and 0201T to include imaging guidance and bone biopsy, when the provider performs these services during the procedure. Although the revision does not essentially require that your provider performs imaging guidance and bone biopsy but the code does include these services when your provider performs them. You should not report these services separately.

This revision to the descriptor for 0200T is part of a larger 2015 revision to the CPT® codes, which was effective for January 1, 2015. The AMA has revised this service to include the diagnostic components of the service.

Note: Since biopsy is inclusive in 0200T and 0201T, you do not submit code 20225 (Biopsy, bone, trocar, or needle; deep [e.g., vertebral body, femur]) with 0200T or 0201T.

What is percutaneous sacroplasty? Percutaneous sacroplasty is a procedure where your physician performs guided injection of polymethylmethacrylate (PMMA) through a needle inserted into the fracture in the vertebral column. Your physician will do sacroplasty for the treatment for symptomatic sacral metastatic lesions and also employ it as an alternative to conservative management for sacral insufficiency fractures (SIFs).

What are sacral insufficiency fractures? SIFs are fractures in the sacral region caused by excessive stress on the weak vertebral bone. This causes backache, especially in the elderly as one of the most common risk factors for SIF is osteoporosis.

Note: “Category III codes are different from Category I CPT® codes as they identify services that may not be performed by many health care professionals across the country, do not have FDA approval, nor does the service/procedure have proven clinical efficacy,” Midkiff says. “To be eligible for a Category III code, the procedure or service must be involved in ongoing or planned research.” Remember to ask your physician for peer reviewed papers that you can document to support the need for the service.

Approach Isn’t Important For Extracranial Vertebral Artery Stenting

When your physician introduces a stent into the extracranial vertebral artery, you submit code 0075T (Transcatheter placement of extracranial vertebral artery stent[s], including radiologic supervision and interpretation, open or percutaneous; initial vessel). For each additional vessel, you submit the add-on code +0076T (Transcatheter placement of extracranial vertebral artery stent[s], including radiologic supervision and interpretation, open or percutaneous; each additional vessel [List separately in addition to code for primary procedure]).

Tip: You report the codes 0075T and 0076T for both open and percutaneous procedures.

What is new in 2015? Effective January 2015, the descriptor of codes 0075T and 0076T have been revised. As compared to the earlier descriptors, the new descriptors now include the following:

1. Applicable to open and percutaneous approaches

2. The codes no longer have reference to intrathoracic carotid placement. The descriptors simply refer to the transcatheter placement of an extracranial vertebral artery stent.

What do the revisions imply? The revisions to the descriptors of codes 0075T and +0076T excludes placement of an intrathoracic carotid stent but the codes still include the service of the provider placing the initial catheter into the extracranial vertebral artery for stenting. The descriptors add the term ‘open’ to indicate that your provider may choose to place the stent through an open procedure directly into the artery or percutaneously, through the skin.

Why these revisions? The AMA has introduced these revisions to distinguish 0075T and +0076T from code 37218 (Transcatheter placement of intravascular stent[s], intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation) and to be clear about the services included in these codes.

Note: When you report category III codes, you contribute to enhancing scientific evidence for research. “The reasoning behind these codes is to assist researchers track emerging technology and services to substantiate widespread usage and clinical efficacy,” Midkiff says. “In the past, researchers have been hampered by the length and requirements of the current CPT® approval process.”