Category III Codes: Use to Prompt Category I Codes
- By John Verhovshek
- In Industry News
- May 1, 2016
- 1 Comment
Discover what new emerging technologies may or may not be coded in 2016.
CPT® Category III codes don’t capture a lot of attention, but they are vital to proper coding. These codes generally do not have an established payment amount; per CPT® guidelines, however, if a Category III code is available, you must report it instead of a Category I unlisted procedure code.
Here’s a summary of significant Category III code changes for 2016.
New Codes for Emerging Technologies
Seizure Data Recording
The Category III codes now include six codes to describe external heart rate and 3-axis accelerometer data recording. Seizure frequency is an important factor when treating epileptic seizures. Per the American Medical Association’s (AMA’s) CPT® Changes 2016: An Insider’s Guide, “The epilepsy seizure monitor-system (0381T-0386T) is similar to the Holter monitor (93224) because of its continuous event recording and interpretation and reporting to a physician or other qualified health care professional. … [but] differ from the Holter monitoring code (92334) in that they capture the target data for epilepsy seizure detection, rather than electrocardiographic (ECG) data.”
The codes are broken down according to the number of days the recording takes place, as well as whether the service includes the report, review, and interpretation; or review and interpretation only.
0381T External heart rate and 3-axis accelerometer data recording up to 14 days to assess changes in heart rate and to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; includes report, scanning analysis with report, review and interpretation by a physician or other qualified health care professional
0382T review and interpretation only
0383T External heart rate and 3-axis accelerometer data recording from 15 to 30 days to assess changes in heart rate and to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; includes report, scanning analysis with report, review and interpretation by a physician or other qualified health care professional
0384T review and interpretation only
0385T External heart rate and 3-axis accelerometer data recording more than 30 days to assess changes in heart rate and to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; includes report, scanning analysis with report, review and interpretation by a physician or other qualified health care professional
0386T review and interpretation only
Leadless Pacemakers
There are five new codes to describe services related to permanent leadless pacemakers:
0387T Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular
0388T Transcatheter removal of permanent leadless pacemaker, ventricular
0389T Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report, leadless pacemaker system
0390T Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure or test with analysis, review and report, leadless pacemaker system
0391T Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, leadless pacemaker system
CPT® Changes 2016 advises, “Existing CPT codes only addressed procedures for traditional pacemaker systems and did not adequately describe the procedure of implanting a leadless pacemaker. Therefore, these codes have been established to report leadless and pocketless system procedures.”
Esophageal Sphincter Augmentation
Esophageal sphincter augmentation is performed for treatment of gastoesophageal reflux disease (GERD). The device employs magnets, placed around the gastroesophageal junction. The attraction of opposing magnets narrows the opening, but allows food to pass when the patient swallows.
0392T Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band)
0393T Removal of esophageal sphincter augmentation device
Myocardial Strain Imaging
CPT® Changes 2016 explains, “Myocardial strain imaging can be used in the diagnosis and management of ischemic heart disease. … For example, in patients undergoing chemotherapy and radiation treatments.”
+0399T Myocardial strain imaging (quantitative assessment of myocardial mechanics using image-based analysis of local myocardial dynamics) (List separately in addition to code for primary procedure)
As an add-on code, 0399T may be applied with 93303, 93304, 93306, 93307, 93308, 93312, 93314, 93315, 93317, 93350, 93351, and 93355.
Multi-spectral Digital Skin Lesion Analysis (MSDSLA)
MSDSLA is an imaging and analysis procedure for lesions that may be high-risk for melanoma, and typically are performed on the same day as an evaluation and management (E/M) service. If biopsy is required following MSDLA, you may report the biopsy codes on the same day.
0400T Multi-spectral digital skin lesion analysis of clinically atypical cutaneous pigmented lesions for detection of melanomas and high risk melanocytic atypia; one to five lesions
0401T six or more lesions
Placement of Ethmoid Sinus Drug Eluting Implant
Two Category III codes were introduced in CPT® 2016 to describe endoscopic ethmoid sinus surgery to implant a stent that delivers a drug (typically, a steroid) to keep the ethmoid sinus patent (open) after surgery, either with or without biopsy, polypectomy, or debridement.
CPT® tells us not to report 0406T Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant; or 0407T Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant; with biopsy, polypectomy or debridement with 31200, 31201, 31205, 31231, 31237, 31240, 31254, 31255, 31288, or 31290 when performed on the same side.
Moving Up to Category I
Category III codes describe emerging technologies, and are often an intermediate step in establishing a Category I code. A few Category III codes deleted for 2016 were replaced by new, Category I codes.
| Deleted Category III Code |
Replacement Category I Code |
| 0099T | 65785 Implantation of intrastromal corneal ring segments |
| 0262T | 33477 Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed |
| 0311T | 93050 Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform(s), digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity artery, non-invasive |
Category III code 0182T is deleted and replaced by two new Category III codes:
0394T High dose rate electronic brachytherapy, skin surface application, per fraction, includes basic dosimetry, when performed
0395T High dose rate electronic brachytherapy, interstitial or intracavitary treatment, per fraction, includes basic dosimetry, when performed
For 0395T, report one unit per fraction, regardless of whether basic dosimetry is performed.
Codes that Didn’t Make the Cut
If a Category III code is not replaced by a Category I code (or otherwise revised) within five years, the Category III code “sunsets” (i.e., is archived), “unless it is demonstrated that a temporary code is still needed.” For 2016, a number of Category III codes have been sunset without establishing a Category I code equivalent. To report these procedures, turn to a Category I unlisted procedure code.
| Deleted Category III Code |
Category I Unlisted Equivalent |
| 0103T 84999 nlisted chemistry procedure 0123T 66999 nlisted procedure, anterior segment of eye 0223T , 0224T, 0225T 93799 nlisted cardiovascular service or procedure 0233T 88749 nlisted in vivo (eg, transcutaneous) laboratory service 0240T , 0241T 91299 nlisted diagnostic gastroenterology procedure 0243T , 0244T 94799 nlisted pulmonary service or procedure |
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John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Asheville, N.C., local chapter.
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I had cataract surgery covered by Humana medicare IN PART on both eyes in March L and April right and it was coded 66999 humana and I were billed $8,000+ with my share $2,250! The MD Surgeon and AC Facility are scaming patients and Medicare!! Any advice or thoughts. This is happening to thousands of Seniors who paid Medicare premiums for 50-60 YEARS!