Anesthesia Coding Alert

Two new Category III codes for sacroplasty went into effect July 1, but you have other Category III codes to watch for when Jan. 1 rolls around.

Several injection codes go live in 2010, but add them to your cheat sheets now because you won't find them in your CPT book until 2011. As a pain management coder, you should pay close attention to ten Category III codes going into effect Jan. 1, 2010, although they didn't make the printer cut-off date for inclusion in CPT 2010.

Several comprise a new family of codes for posterior intrafacet implants:

• 0219T -- Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; cervical

• 0220T -- ... thoracic

• 0221T -- ... lumbar

• +0222T -- ... each additional vertebral segment (List separately in addition to code for primary procedure).

Welcome addition: Pain management specialists have expanded their services in recent years to include several minimally invasive procedures, such as facet joint fusion.

"This is commonly performed due to spondylosis/facet joint disease rather than completing a more invasive fusion," says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver.

Coders might have relied on an "unlisted procedure" code or open fusion codes, such as 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]), when reporting facet joint fusion procedures in the past. Now you could find yourself filing more accurate claims, thanks to the new options.

Six other new codes deal with paravertebral facet joint injections:

• 0213T -- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level 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).

Reminder: Once the Category III codes go into effect you should report those instead of any "unlisted" codes or other procedures you filed previously, Hammer says

The AMA announced new spine-related Category III codes, implemented July 1, including two for sacroplasty. Be sure you've been reporting these cases correctly, retroactive to Jan. 1, 2009:

• 0200T -- Percutaneous sacral augmentation [sacroplasty], unilateral injection[s], including the use of a balloon or mechanical device [if utilized], one or more needles

• 0201T -- Percutaneous sacral augmentation [sacroplasty], bilateral injections, including the use of a balloon or mechanical device [if utilized], two or more needles.

CMS added these two Category III codes to the physician fee schedule with a "C" procedure status, meaning individual carriers would establish payment amounts. Because the codes are carrier-priced, the national fee schedule does not include relative value units.

"It will be interesting to see how carriers price the sacroplasty codes, since many were not paying for this service with the unlisted procedure code 22899 (Unlisted procedure, spine)," says Mary Rice, a coding and practice management consultant in Memphis, Tenn.

Some of the new Category III codes include radiologic interpretation, so keep these tips in mind when completing your claims:

• You can report radiological supervision and interpretation for 00200T and 00201T. Choose between 72291 (Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation including cavity creation, per vertebral body; under fluoroscopic guidance), or 72292 (... under CT guidance).

• Don't report radiological supervision and interpretation in conjunction with 0219T-0221T because the guidelines specifically direct, "Do not report 0219T-0221T with any radiological service."

Bilateral note: Some of the new Category III codes also include details regarding bilateral coding. Append modifier 50 (Bilateral procedure) when your physician's documentation supports it. You can include modifier 50 with 0213T-+0218T, but not 0219T-+0222T.

Requirement: CPT instructions are clear on Category III code use -- report them instead of an unlisted procedure Category I code whenever available. Because coverage and reimbursement remains a payer decision, you should follow the same process with reporting Category III codes as you do with unlisted-procedure Category I codes.

With Category III codes, you're not only following the instructions provided by CPT, but you're providing data that could help support a Category I code in the future.

Resource: The list of new Category III codes is on the AMAWeb site at www.ama-assn.org/ama1/pub/upload/mm/362/cptcat3codes.pdf.