2017 Category III Codes Tell All

Changes to this section in CPT^® reveal the latest medical technologies.

CPT® Category III codes describe emerging technologies and allow for data tracking. If a Category III code is available, you must report it instead of a Category I unlisted procedure code. CPT® 2017 includes substantial Category III code changes, of which you’ll need to be aware to ensure proper coding. Here are the highlights.

Deletions

A Category III code is deleted because it has either been replaced by a Category I code or it has not been replaced by a Category I code in five years. In the latter case, most often you will return to reporting an unlisted procedure Category I code in place of the deleted Category III code. Table 1 provides a full listing of deleted Category III codes, as well as their replacement codes for 2017.

Revisions

Descriptor revisions are relatively few this year. Codes 0274T and 0275T, which describe Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), single or multiple levels, unilateral or bilateral, by spinal region, are revised to remove the phrase “with or without the use of an endoscope.” For percutaneous decompression of the nucleus pulposus of intervertebral disc using need-based technique, see instead 62287 Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar.
CPT® no longer defines moderate sedation as an inherent part of any procedure (including Category III procedures). Per the 2017 Medicare Physician Fee Schedule Final Rule, “This coding change [provides] for payment for moderate sedation services only in cases where it is furnished.” Moderate sedation, when performed and properly documented, now is reported separately using new codes 99151-99157.
Table 1: 2017 Deleted CPT® Category III Codes 

Tip: For more on this, read “CPT® 2017: Big Changes that Won’t Put You to Sleep,” in the December 2016 issue of Healthcare Business Monthly.

New Codes

Cardiac contractility modulation
Cardiac contractility modulation (CCM) delivers non-excitatory electrical signals to improve ventricular function. The complete system includes a pulse generator with one atrial and two ventricular electrodes (leads). New codes 0408T-0418T describe procedures and services related to CCM devices, such as insertion, replacement, and removal of components, as well as device programming and interrogation. Many of these services include associated catheterization and imaging guidance.
Destruction of neurofibroma
New codes 0419T Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); face, head and neck, greater than 50 neurofibromas and 0420T Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); trunk and extremities, extensive, greater than 100 neurofibromas describe destruction of extensive neurofibroma on the face, head, and neck (0419T), and trunk and extremities, respectively. For excision of neurofibroma, report 64792 Excision of neurofibroma or neurolemmoma; extensive (including malignant type).
Transurethral waterjet ablation of prostate
Benign prostatic hyperplasia may lead to chronic bladder-outlet obstruction and symptoms such as urinary retention, urinary frequency, incomplete bladder emptying, blood in the urine, and renal insufficiency. Transurethral waterjet ablation (e.g., an aquablation system) delivers a high-velocity saline stream under ultrasound guidance to ablate prostatic glandular tissue without heat.
New code 0421T Transurethral waterjet ablation of prostate, including control of post-operative bleeding, including ultrasound guidance, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed) describes waterjet ablation of the prostate with ultrasound guidance.
Tactile breast imaging 
The tactile imaging system uses a handheld scan head equipped with pressure sensor elements and a magnetic position tracker that the physician strokes over the breast. A computer digitizes the tactile pressure images and locations to help evaluate and size lumps in the breast(s). Code 0422T Tactile breast imaging by computer-aided tactile sensors, unilateral or bilateral describes unilateral (one breast) or bilateral (both breasts) tactile imaging.
Neurostimulator system for
treatment of central sleep apnea
The neurostimulator system for treatment of central sleep apnea includes a breathing sensor and a stimulation lead powered by a small battery. During sleep, the system senses breathing patterns and delivers mild stimulation to the tongue and other soft tissues of the throat to keep the airway open. New codes 0424T-0436T describe services and procedures related to such a system, including insertion, replacement, and removal of the components, as well as device interrogation and programming with or without sleep study.
Synthetic implant
(e.g., polypropylene) for fascial reinforcement 
Polypropylene may be used to reinforce the fascia in the abdominal wall (for example, to repair ventral hernia). You may report +0437T Implantation of non-biologic or synthetic implant (eg, polypropylene) for fascial reinforcement of the abdominal wall (List separately in addition to code for primary procedure), in addition to a primary surgical service, for use of non-biologic or synthetic implant, only. For mesh or other prosthesis for open incision or ventral hernia repair, or for closure of a necrotizing soft tissue infection wound, see +49568 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair), which carries over unchanged from 2016.
Transperineal placement of biodegradable material
New code 0438T Transperineal placement of biodegradable material, periprostatic (via needle), single or multiple, includes image guidance replaces HCPCS Level II code C9743 to describe placement, via needle, of a biodegradable implant(s) that is meant to temporarily position the anterior rectal wall away from the prostate during radiotherapy for prostate cancer. This reduces the radiation dose delivered to the anterior rectum.
Nerve cryoablation
Cryoablation (freezing) may be used to ablate nerves for pain relief. Report this service with new codes 0440T Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve and 0441T Ablation, percutaneous, cryoablation, includes imaging guidance; lower extremity distal/peripheral nerve.
Drug-eluting ocular inserts
Drugs used to treat the eye and surrounding tissues can be dispensed via an ocular insert, as can drugs that will pass through the eye and surrounding tissues to the blood stream, but which are not used in therapy of the eye itself. New code 0444T Initial placement of a drug-eluting ocular insert under one or more eyelids, including fitting, training, and insertion, unilateral or bilateral reports an initial unilateral (one eye) or bilateral (both eyes) placement of the insert, including fitting and training. Report 0445T Subsequent placement of a drug-eluting ocular insert under one or more eyelids, including re-training, and removal of existing insert, unilateral or bilateral for subsequent placements. For insertion and removal of each drug-eluting implant into lacrimal canaliculu, report 0356T Insertion of drug-eluding implant (including punctual dilation and implant removal when performed) into lacrimal canaliculus, each.
Interstitial glucose sensor 
Glucose sensors are employed to help normalize blood glucose in diabetic patients. An implantable system allows for constant monitoring. Codes 0446T-0448T describe procedures and services related to such glucose sensor systems, including creation of a subcutaneous pocket to house the sensor, removal, and revision. For placement of a non-implantable interstitial glucose sensor without a pocket, use 95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording.
Insertion of aqueous drainage device
An aqueous drainage device is a method to reduce intraocular pressure in patients with glaucoma. Code 0449T Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device describes insertion of an initial device into the subconjunctival space, by internal approach. For each additional device, report +0450T Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; each additional device (List separately in addition to code for primary procedure). For removal, report 92499 Unlisted ophthalmological service or procedure.
Aortic counterpulsation ventricular assist systems 
Aortic counterpulsation ventricular assist systems are used to treat congestive heart failure. CPT® provides an extensive explanation of these systems, and how they differ from other services for the implantation, revision, and removal of existing aortic balloon pumps. The device is comprised of several parts: the counterpulsation device, vascular graft, implantable vascular hemostatic seal, mechano-electrical skin interface, and subcutaneous electrodes. CPT® lists additional included services (e.g., all vessel catheterizations, diagnostic angiography, etc.).
New codes 0451T-0463T describe procedures related to the insertion/replacement, removal, and relocation of system components, as well as programming and interrogation device evaluation.
 

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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