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Best Practices to Ensure Coding Accuracy for Errata, Category III Codes and CMS & AMA Updates

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Diligent ASC coders always make sure they have the most current information from manuals, coding software, Medicare edits and the like. But sometimes they forget to check for updates that coding authorities issue during the year, such as Errata, new Category III codes and monthly updates from CMS and the AMA.

1. Look for Errata after coding manuals are issued
Errata are corrections issued after the original CPT, HCPCS and ICD-9-CM coding manuals are published. ASC coders should review Errata and make the necessary revisions of their respective manuals. Failure to do so could impact reimbursement. Here are a few modifications of code directives, as documented in CPT and HCPCS Errata for 2010.

CPT Errata. The following CPT Errata corrects the CPT manual's original direction to report unlisted code 64999. Note that the Errata crosses out the unlisted code and substitutes it with several Category III codes.

"Paravertebral Spinal Nerves and Branches (Image guidance [fluoroscopy or CT] and any injection of contrast are inclusive components of codes 64490-64495. Imaging guidance and localization are required for the performance of paravertebral facet joint injections described by codes 64490-64495. If imaging is not used, report code 20550-20553. If ultrasound guidance is used report 64999 0213T-0218T)."


Category III Codes 0213T-0218T do not appear in the AMA CPT Book for 2010 but they were implemented on Jan. 1.  These Category III codes include:

  • 0213T - Facet injection(s), with ultrasound guidance, cervical or thoracic; single level  (MCR 2010 $288.44)
  • 0214T - Facet injection(s), with ultrasound guidance, cervical or thoracic; second level  (MCR 2010 $102.38)
  • 0215T - Facet injection(s), with ultrasound guidance, cervical or thoracic; third and any additional  level(s) (MCR 2010 $102.38)
  • 0216T - Facet injection(s), with ultrasound guidance, lumbar or sacral; single level (MCR 2010 $288.44)
  • 0217T - Facet injection(s), with ultrasound guidance, lumbar or sacral; second level (MCR 2010 $102.38)
  • 0218T - Facet injection(s), with ultrasound guidance, lumbar or sacral; third and any additional level(s) (MCR 2010 $102.38)

The most recent CPT 2010 Errata may be obtained from the AMA by clicking here (pdf).

HCPCS Errata.
CMS has released a modification to the HCPCS code set. It has revised the original 2010 verbiage for HCPCS code L8680, "Implantable neurostimulator electrode (with any number of contact points), each" to state "Implantable neurostimulator, each."

With this change, the CY 2010 definition for L8680 reverts to the verbiage reflected in the 2009 HCPCS code set allowing for each electrode to be reported and reimbursed pending carrier guidelines. While CMS packages L8680 into the reimbursement for the main procedure being performed, commercial carriers may allow separate reimbursement per electrode. Facilities should verify carrier policies/contracts.

This change has been posted to the 2010 HCPCS Corrections document located on the HCPCS Web page by clicking here and looking under “2010 HCPCS Corrections 12/18/2009.

2. New Category III codes for orthopedic procedures and pain management injections start July 1
Category III codes are a temporary set of codes for emerging technologies, procedures and services that are released on a semi-annual basis and effective six months later. Here are two newly released Category III codes that will take effect on July 1.

Platelet rich plasma injections.
PRP injections involve collecting a patient’s blood, separating out the platelet rich portion, containing the growth factors and injecting it back into the injury site.

PRP should be reported as 0232T (injection[s], platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed). However, CPT instructs not to report 0232T in conjunction with 20550, 20551, 20926, 76942, 77002, 77012, 77021 and 86965.

The following components are included in the PRP and cannot be billed separately.
20550-20551 - tendon and tendon sheath injection
20926 - tissue graft
76942, 77002, 77012, 77021 - imaging
86965 - pooling of platelets or other blood products

Once implemented, it is important to verify with your Medicare administrative contractor and commercial carriers as to individual reporting and reimbursement policies for the PRP procedure.

Transforaminal epidurals with ultrasound. There are already CPT codes (64479, 64480, 64483, 64484) to cover transforaminal epidural injections, which treat leg and back pain, often administered laterally through the selected neuroforamen. However, new category III codes will cover transforaminal epidurals with ultrasound. Note the following new codes:
  • 0228T (injection[s], anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level).
  • 0229T (each additional level [List separately in addition to code for primary procedure]).
  • 0230T (injection[s], anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level).
  • 0231T (each additional level [List separately in addition to code for primary procedure]).

Note that codes for PRP and transformational injections with ultrasound codes will be included in the 2011 CPT manual.

See the AMA announcement by clicking here (pdf).

3. Stay on top of periodic updates from AMA and CMS
The AMA adds new directives made throughout the year for procedures found within its CPT manual while CMS offers new directives for reporting procedures, services or supplies. Here are two of the most recent directives provided by the AMA and CMS:

AMA's directive on excision of soft tissue tumors. Based on the Feb. 2010 AMA CPT Assistant, clarification was made to reporting the excision of soft tissue tumors. When the AMA was asked how to determine reporting of a large soft tissue tumor, the AMA provides clarification that the size of the entire resection — not the diameter of the lesion — will determine the code selection providing the example, "if a tumor is 4.5 cm wide, but requires a resection of 7 cm of tissue to excise the required margins, it is coded as a 7 cm lesion."  For more detailed information regarding the newly revised soft tissue tumors, refer to the AMA CPT Assistant Febr. 2010 Volume 20 Issue 2.

CMS directive on use of intraocular lenses in ASCs.
According to the Medicare Claims Processing Manual Chapter 14 - Ambulatory Surgical Centers, in regards to IOLs, for services on and after Jan. 1, ASCs are to bill for the insertion of a new technology intraocular lens (NTIOL) that is also an approved A-C IOL or P-C IOL, concurrent with cataract extraction, using not two but three separate codes. According to CMS, ASCs shall use either HCPCS code V2787 or V2788, as appropriate, to report charges associated with the non-covered functionality of the A-C IOL or P-C IOL, the appropriate HCPCS code for the cataract removal procedure (i.e. 66982 or 66984) and NTIOL category 3 code Q1003 to report the covered NTIOL aspect of the lens on claims for insertion of an A-C IOL or P-C IOL that is also designated as an NTIOL. At this time, A-C IOLS SN6AT3, SN6AT4 and SN6AT5 are also cumulatively listed as NTIOLs under the model number SN6ATT. Facilities should verify reporting policies to include modifier applications with individual MAC carriers.

Additional information can be obtained directly from the CMS Web site for current listings of the CMS-approved Category III NTIOLs, A-C IOLs and P-C IOLs as well as a copy of the Medicare Claims Processing Manual Chapter 14.

Cristina Bentin can be reached at cristina@ccmpro.com. Learn more about Coding Compliance Management.

The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.


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