General Surgery Coding Alert

Learn tumor ablation options.

Maybe you’re quick to check the first four CPT^® surgery sections each year for code changes that might affect your general surgery practice. But if you often fail to turn to the Category III code section because it’s off your radar screen, we have the update for you.

Read on to learn about new “temporary” codes that you might need to report beginning Jan. 1 when CPT^® 2020 goes into effect.

Recognize Code Hierarchy

Whether you call them “T-codes” or Category III codes, you need to know the purpose and placement of this unique grouping that includes some procedures your general surgeons might perform.

Purpose: These are temporary codes, primarily intended to allow collection of specific data that using an “unlisted” code does not allow. The CPT^® guidelines for the Category III section states that the codes provide an opportunity for stakeholders “to identify emerging technology, services, procedures, and service paradigms for clinical efficacy, utilization, and outcomes.”

“The need for these codes [arose] due to the development of new technology,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania.

Priority: Because the purpose is data collection, CPT^® guidelines indicate that if a Category III code is available for a service, you must use that code instead of an unlisted Category I code.

From a billing standpoint, keep in mind that Category III codes often apply to services that payers consider investigational/experimental. “It may be a while before this service is rendered effective and covered,” Pohlig says.

Check expiration: Remember that Category III codes have an expiration date, typically after five years. CPT^® either converts the procedure to a Category I code before that date, or archives the code at the deadline due to limited use. “If you use any Category III codes, you need to check every year to ensure that each code is still valid,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, national director of marketing and revenue management at FasPsych in Omaha, Nebr.

Do this: If a Category III code that you use has been deleted, you need to learn if it has been replaced with a new Category I code that you should use instead.

Check Out New Codes

CPT^® 2020 adds the following two new codes for tumor ablation, depending on anatomic site:

• 0581T (Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral)
• 0582T (Transurethral ablation of malignant prostate tissue by high-energy water vapor thermotherapy, including intraoperative imaging and needle guidance)

CPT^® already provides site-specific ablation codes for other tumors, such as liver, colon, lung, or kidney, but these are the first codes for breast or prostate tissue.

Breast margin: You’ll find another new temporary code for breast surgeries in 2020: 0546T (Radiofrequency spectroscopy, real time, intraoperative margin assessment, at the time of partial mastectomy, with report).

AV anastomosis: If your surgeon performs vascular procedures, you might also need to know about new temporary code 0553T (Percutaneous transcatheter placement of iliac arteriovenous anastomosis implant, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention).