March 01, 2013
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, MA, CPC. Mr. Verhovshek is the managing editor for AAPC, a training and credentialing association for the business side of health care.
For 2013, CPT® includes a total of 47 changes to Category III codes. Category III (temporary) codes often aren’t reimbursed by insurers and aren’t assigned relative values in the Medicare physician fee schedule. So why bother reporting them?
For two reasons:
- Because CPT® says so. Per American Medical Association (AMA) guidelines, if a Category III code is available to describe a procedure or service, you must report it instead of a Category I unlisted procedure code.
- Because it’s the right thing to do. Reporting Category III codes allows tracking of emerging technologies, which often leads to the establishment of Category I codes (which generally do pay).
Not every Category III code will make the transition, however; if a Category III code is not replaced by a Category I code (or otherwise revised) within five years, the Category III code will “sunset,” unless there is a demonstrated need to continue the temporary code.
Just three Category III codes have been revised for 2013. In each case, the revisions were made to provide greater clarity on how or when to apply the code.
Category III codes 0195T and 0196T were revised to specify “without instrumentation,” to distinguish them from new code 22586. 0206T was revised to clarify that the procedure is performed for coronary artery obstruction severity assessment, but is not intended for cardiac ischemia.
Sixteen Category III codes were deleted this year. In all but two cases, new Category I codes were established to replace the deleted codes.
Brand new for 2013, add-on Category III codes describe intravascular optical coherence tomography to gather microstructural information on atherosclerotic plaques. Code 0291T describes the initial vessel, while 0292T describes each additional vessel. Both codes include imaging supervision, interpretation and report, as well as conscious sedation, when provided. The codes are reported in addition to the primary cardiac catheterization. Codes 0293T and 0294T describe insertion of a device to monitor left atrial pressure to identify pressure changes in patients with heart failure, or a similar procedure performed during insertion of a pacing cardioverter-defibrillator, respectively.
New codes describe external electrocardiographic recording for more than 48 hours, up to 21 days. Combination code 0295T describes all of the components (recording, scanning analysis with report, review and interpretation). Codes 0296T-0298T report the component services separately. Report code 0296T for recording only, 0297T for scanning analysis with report only and 0298T for review and interpretation only. Extracorporeal shock wave treatment (ESWT), now reported with 0299T and 0300T, has been shown in the clinical setting to promote the healing of burns and other difficult-to-heal wounds. Claim 0299T for the initial wound and 0300T for each additional wound.
There are also new codes to describe procedures related to intracardiac ischemic monitoring devices. New codes report insertion of the complete system (which includes a generator, adaptor and transvenous lead), insertion of individual components when the entire system is not inserted, removal of the system, programming and interrogation. All procedures include conscious sedation, when provided.
A new subset of six Category III codes also now describes procedures related to vagal nerve blocking, which employs a device (consisting of a neurostimulator electrode array and pulse generator) to block hunger and satiety signals from the vagus nerve and does not alter the anatomy of the stomach.