Meet CPT®’s Newest Category III Codes

Thu, Jun 9, 2016 --

Coding Updates

CPT Codes Q3 Updates, category III codes, CPT® codes, new codes

We’re rapidly approaching our midyear point, when CMS and AMA’s 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.

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 don’t have 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. That’s 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.

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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About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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4 Comments For This Post

  1. jitendra Says:

    as a coder I use to use only one category three code 0159T for use of CAD in MRI breast exam, today i learned more about these category codes…thanks for sharing

  2. Susan Dooley Says:

    Hi, Jitendra, very glad that was useful! Susan

  3. Pam Says:

    Hi Does anyone have any information on Scrambler therapy 0278T? Is this modality ever going to be covered.

  4. Deborah Marsh Says:

    Hi, Pam – Interesting question. Would love to hear if anyone out there has experience with specific payers covering 0278T. It’s worth noting that the sunset date for the code got extended from 2017 to 2022.

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