Wiki Iovera Coding and Reimbursement Question

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dgerry

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Hi, we are looking to start this procedure for patients pre-total knee replacement. The company is telling us to bill 64640, "Destruction by neurolytic agent; other peripheral nerve or branch" and U/S guidance based upon an AMA opinion from 2013. In 2017 Category III code 0441T was added and the descriptor is :"Ablation, percutaneous, cryoablation, includes imaging guidance; lower extremity distal/peripheral nerve". Not sure which coding advice to use and any assistance is greatly appreciated.
 
One of our clinics is looking into using Iovera as well and I'm researching for coding guidance as well. AMA clarified in October 2017 that cryoanalgesia of the peripheral nerve (ex. genicular) is coded as 64640. However, in the beginning of 64640's section, CPT states not to report a code labeled as destruction when using therapies that are not destructive of the target nerve. Also, Optum's lay description of 64640's thermal technique states heat. Iovera also doesn't destroy or kill a nerve, it just degenerates the myelin sheath and axon structures to stop the pain and then they regenerate. The lay description of 0441T sounds awfully close to what Iovera actually does. I don't have the answers yet until I have a discussion with my providers regarding the classification of the Iovera technique but I will not (never) just heed to what the reps are saying. In the literature that I was provided, they used the CPT code 64640's RVUs to illustrate the reimbursement but it also stated that coding is the sole responsibility of the healthcare provider. It sounds like a very promising therapy for patients but it's looking like a reimbursement nightmare.
 
Iovera

Any updates on this injection? I too have read info on this and 0441T does sound like the correct code but I want to be sure I'm not missing anything.

Thanks!
Michelle
 
Iovera interest

Our physicians are also interested in using Iovera prior to doing total knee arthroplasty. Their reps are also telling us to use 64640 along with 76942 for the ultrasound guidance. But from my understanding if there is a Category III code that covers the complete procedure you should use that and not an unlisted code. Although 64640 and 76942 are not unlisted the Category III code of 0441T- Ablation, percutaneous, cryoablation, includes imaging guidance: lower extremity distal/peripheral nerve is what we would be doing. Shouldn't we be using that or would the 64640 and 76942 be appropriate?
 
iovera coding- ATTN CodingKing

CodingKing- Could you please contact me via AAPC private message? I tried to send a private msg but it's being rejected stating your inbox is full. tia! chris
 
It still looks like there is some controversy about which code should be used for this procedure. From what I have researched, I would have to agree with using the Category III code group 0440T-0442T. Has anyone tried to bill this & if so what code(s) are being used.
  1. 0440T-0442T - Cryoablation of a nerve is performed to relieve chronic nerve pain by damaging the nerve's myelin coating thereby blocking the pain signal to the brain. The patient typically receives conscious sedation during the insertion of the cryoprobe into the nerve causing the pain. With the probe in place, the patient may be further sedated and/or a nerve block is performed with lidocaine. Imaging guidance is utilized to guide the probe placement and verify optimal position. A freezing agent is administered through the probe by way of tubing connecting it to the system distributing liquid nitrogen or argon gas. The system controls the flow of the freezing agent. Upon completion of the procedure, the probe is removed, pressure is applied to stop bleeding, and the skin is bandaged. Report 0440T when an upper extremity distal/peripheral nerve is treated; 0441T when a lower extremity distal/peripheral nerve is treated; and 0442T when a nerve plexus or other truncal nerve is treated.
 
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