5 Tips to Keep Your CPT® Category III Coding on Track

five Category III CPT coding tips

Category III CPT® codes are separate from the more commonly used Category I codes, making it all too easy to overlook these important codes. Follow the five tips below to help ensure your coding is accurate for Category III codes.

1. Update Cat. III Codes Twice a Year

Consider this question: When are CPT® codes updated? January 1 is the answer a lot of medical coders automatically reply with. But the CPT® update calendar is not that simple, and Category III is one of the complications.

The American Medical Association (AMA) implements new CPT® Category III codes July 1 and January 1. Category III codes are temporary codes that represent “emerging technologies, services, procedures, and service paradigms,” according to the CPT® guidelines. By releasing these codes twice a year instead of once, providers have faster access to these cutting-edge codes.

Coding books get updated only once a year, so if you use books, be sure to check the AMA Category III website to be sure you’re aware of the latest updates. If you use an online medical coding resource, it likely adds updates throughout the year. (SuperCoder coding packages do.)

For January 2020, there will be more than 30 new Category III codes, covering a wide variety of services in, from 0563T for meibomian gland evacuation to 0593T for health and well-being coaching for a group.

2. Use Cat. III Code When Available

“If a Category III code is available, this code must be reported instead of a Category I unlisted code,” the CPT® guidelines state.

One reason this rule is so important is that Category III codes are specific to the services they describe. By reporting the code, you contribute to data collection on how often providers perform the service. Decision makers can then use that data to determine things like coverage and whether to move the code to a more permanent place in Category I.

3. Read the Guidelines With Your Code

Category III codes are in their own section and do not follow any particular order based on service type. In other words, while Category I codes are divided into sections like E/M and Surgery with clearly defined subsections, the temporary Category III codes don’t follow that same rule. That means you need to take extra care to look for guidelines near your Category III codes in your coding resource.

In some cases, the guidelines can be lengthy. For instance, the guidelines accompanying new transcatheter tricuspid valve repair codes 0569T and 0570T are roughly a page, covering areas like what the codes include and what you may report separately. There are also parenthetical notes after the codes reminding you which codes you should not report in conjunction with the new codes.

4. Check NCCI Edits

Category III codes are not immune from National Correct Coding Initiative (NCCI) edits. You should check each quarter for changes to the separate Medicare and Medicaid Procedure to Procedure (PTP) NCCI edits. There are distinct sets of NCCI edits for practitioner reporting and for outpatient facility reporting.

As an example, the Medicare practitioner PTP NCCI edits effective Jan. 1, 2020, will have 34 new edits with new fallopian tube occlusion code 0567T in the column 1 position. The column 2 codes include Category I CPT® codes, Category III CPT® codes, and HCPCS Level II codes.

Caution: Even though there are NCCI edits for Category III codes, you still need to read and apply the guidelines in the CPT® code set regarding which codes you may report together. Don’t assume there’s an NCCI edit for every code pair the guidelines tell you not to report together.

5. Review Your Payers’ Policies

Because the services that Category III codes cover are “emerging,” payers may consider those services investigational. Consequently, payers may not cover those services. Research the policies for the services your practice performs or is considering performing to get a handle on whether payers will reimburse you. That way your practice and patients can make an informed decision.

If the payer does cover the Category III service, there may be specific documentation, coding, and service requirements that your practice needs to be familiar with to improve your chances of reimbursement. (As always, coding must match documentation, which must match what was performed. Documenting or coding services that did not occur is a major compliance issue.)

What About You?

Do you report Category III codes? What strategies do you use to improve your chances of ethical reimbursement for services your practice provided?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

,

Leave a Reply