Meet CPT®’s Newest Category III Codes

7/26/2019 Meet CPTs Newest Category III Codes

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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,

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Meet CPTs Newest Category III Codes

By Susan Dooley

Were rapidly approaching our midyear point, when CMS and AMAs release new CPT category III codes

go into effect on July 1, 2016. Part of the quarterly update to the Medicare Physician Fee Schedule

Database, the new codes belong to the temporary set of codes used to report emerging technologies,

services, and procedures.
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Category III Codes Capture Emerging Technology and Procedures

CMS explains that the new July 2016 CPT Category III codes carry no relative value units (RVUs), which

means they are not reimbursable. These July codes actually have status C, which means that coverage

and payment is up to local Medicare Administrative Contractors (MACs). Category III codes track the

use of new technology, services, and procedures, and they must have relevance for research, be it

ongoing or planned. By tracking these codes, researchers can determine how frequently emerging

procedures are performed. Data collected from use of these category III codes can be used as part of the

Food and Drug Administration (FDA) approval process for some items.

Conversion from Category III to Category I Code Status

The American Medical Association sunsets its category III codes after five years from their publication

in the CPT code book. For example, the category III codes that go live in July 2016 will be published in

the 2017 CPT code book, so their sunset date is in 2022. Sunset means that if category III codes have

not been accepted for placement in the category I section of CPT, they get archived or, if it turns out

the category III code is still needed, it is retained in category III status.

For example, in January 2016, the AMA converted category III code 0311T to category I code 93050

(Arterial pressure waveform analysis). This noninvasive diagnostic study measures arterial pressure in

patients with resistant hypertension.

Coders take note: Even though category III codes typically carry no reimbursement value, if a category III

code is available that accurately describes the procedure or service performed, this code must be

reported instead of a category I unlisted code.

Meet Some New T Codes!

Nine new category III codes go into effect on July 1 as part of the 2017 CPT production cycle. We donthave room to talk about all of them, but here are some highlights.

Nonbiologic Abdominal Wall Mesh

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)

When patients need repair of abdominal wall hernias, the weak musculature often requires

reinforcement to prevent future herniation of abdominal contents. Thats where mesh reinforcement

comes in.

We have existing category I codes for hernia repair with mesh, but 0437T tracks use of nonbiologic

implants to reinforce the abdominal wall fascia. Porcine and bovine-based mesh, as well as cadaveric

human dermis-based mesh, are popular choices, but synthetic mesh may be more cost effective. Hence,

0437T allows researchers the ability to track the use of synthetic mesh implants in abdominal wall repair

procedures. The new code includes guidance regarding which primary category I codes to report

alongside 0437T.
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Cryoablation of Nerves

0440T, Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity

distal/peripheral nerve

0441T, lower extremity distal/peripheral nerve

0442T, nerve plexus or other truncal nerve (eg, brachial plexus, pudendal nerve)

Cryoablation, the process of freezing a nerve, may be a helpful treatment for patients with intractable

nerve pain, such as that caused by postsurgical injury, post-herpetic neuralgia, and chronic

radiculopathy. CPT gives us three new category III codes for this procedure, for cryoneurolysis or

cryoablation of an upper extremity, lower extremity, and nerve plexus or truncal nerve, respectively.

During this procedure, the provider inserts a cryoablation needle into the nerve that causes the pain,

the patient is sedated, and a nerve block is created. In one study, patients reported that their pain, on a

scale of 0 to 10, dropped to almost 0 immediately after the procedure. These patients had reported pain

scores of about 8 on the same scale, prior to the procedure. Before the release of these three new T

codes on July 1, coders had to report these procedures with 64999 (Unlisted procedure, nervous

system).

What About You?

After 36 years in health information management, I never cease to get excited about new procedures

and technology helping to improve patient care. How about you? Is your practice doing something new

and exciting? Let us know in the comment box below.

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Contact Us:

Name: Sam Nair

Title: Associate Director

Email:[email protected]

Direct: 704 303 8150

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713
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Meet CPT®’s Newest Category III Codes