Learn the simple code changes 2020 in the complex Nervous system

This article deals with the nervous system code changes 2020. The highlights of the changes would include the new codes introduced for genicular nerve procedures and spinal puncture.

Spinal puncture:

Spinal puncture also called as “spinal tap” or “lumbar puncture” is the insertion of a needle into the spinal canal to collect and examine the cerebrospinal fluid. It may be performed to diagnose diseases such as meningitis or any other neurologic disease or therapeutic purpose to administer antibiotics, chemotherapy drugs or anesthetic agents into the spinal canal.

Lumbar puncture codes are revised and expanded by the addition of two new codes that incorporate fluoroscopic or CT imaging guidance.

New codes:

62328: Spinal puncture, lumbar, diagnostic; with fluoroscopic or CT guidance

62329: Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter); with fluoroscopic or CT guidance

Coders should not report 62328 and 62329 with 77003, 77012 as it incorporates fluoroscopic or CT guidance in its code description. If ultrasound or MRI guidance is used, then add 76942 or 77021 to the spinal puncture codes 62270 or 62272 instead of using the new codes 62328 and 62329. These new codes are applicable only when fluoroscopic or CT guidance is utilized.

Revised codes:

▲62270 Spinal puncture, lumbar, diagnostic;

▲62272 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter);

The next set of new codes was added for the destruction, radiofrequency ablation and injection of agents into nerves of sacroiliac joint and genicular nerve. It is really great news for the coders as there were so many debates and confusions to assign the correct codes for genicular nerves as it has no specific code in the past.

1. Genicular nerve block:

Genicular nerve block is a relatively new technique used to treat severe knee pain that has not responded to other treatments. There are typically 3 branches targeted with genicular nerve block:

  • the superior medial branch( SM),
  • the superior lateral branch (SL), and
  • the interior medial(IM) genicular nerves.

A Genicular nerve block is a procedure where a small amount of local anaesthetic (1-2ml) of lidocaine or bupivacaine is injected around the superior lateral (SL), superior medial (SM) and the inferior medial (IM) branches.

Code 64454: Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed

Note: Code 64454 requires injection of all three of these branches: Superolateral, superomedial, and inferomedial. Coders should check whether the documentation supports the injection of all three branches. If not, then report 64454-52.

2. Genicular Nerve Radiofrequency Ablation: GNRFA

The GNRFA procedure is typically performed with local anesthetic, although moderate IV sedation may be offered. Either ultrasound or fluoroscopic guidance may be used. Following local anesthetic infiltration, a radiofrequency cannula is guided to the locations of each nerve and radiofrequency ablation is performed at a temperature of 70 C for 90 seconds.

Code: 64624:Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed.

Note: Code 64624 requires destruction of each of the following genicular nerve branches: Superolateral, superomedial, and inferomedial. If neurolytic agent is not applied to all three branches then coders should use 64634-52.

3. Sacroiliac joint nerve injection procedures:

The sacroiliac joint is well innervated and receives its innervation from the ventral rami of L4 and L5, the superior gluteal nerve, and the dorsal rami of L5, S1, and S2, or that it is almost exclusively derived from the sacral dorsal rami. New codes were introduced to report the injection and radiofrequency ablation of the nerves innervating the sacroiliac joint.

Code 64451:Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (fluoroscopy or computed tomography)

Key points to remember when coding 64451:

  • Coders should use 64451 when the injection involves the usage of fluoroscopic or computed tomography guidance. If ultrasound is used, then coders should report code 76999.
  • Coders should not report 64451 in conjunction with 64493, 64494, 64495, 77002, 77012, 95873, and 95874.
  • For bilateral procedures, append modifier 50.
  • Code 64451 is entirely different from code 27096. Code 64451 is to be reported if the injection is performed for the nerves innervating the sacroiliac joint and code 27096 is to be reported if the injection is performed for the sacroiliac joint.

4. Radiofrequency of Sacroiliac joint nerve procedures:

Code 64625: Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (fluoroscopy or computed tomography)

Key points to remember when coding 64625:

  • Coders should use 64625 when the ablation involves the usage of fluoroscopic or computed tomography guidance. If ultrasound is used, then coders should report code 76999.
  • Coders should not report 64625 in conjunction with 64636, 77002, 77003, 77012, 95873 and 95874.

Revised codes:

There are several codes revised in the Nervous system. Let’s see an example of the revised codes as below:

The revision of the injection codes is based on the two key elements:

1. Introduction of new term “and/or steroid:

The new term “and/or steroid “has been added to the existing injection codes and the revised codes are 64405, 64408, 64416, 64417, 64418, 64425, 64430, 64435, 64446, 64448, 64449 and 64450. Example is listed below:

2019 code description:

64400 – Injection, anesthetic agent, trigeminal nerve, any division or branch each branch.

2020 code description:

▲64400 – Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, any division or branch each branch (ie, ophthalmic, maxillary, mandibular)

2. Addition of “level”:

The new term “level” has been added to show more specificity in the codes. Example is listed below:

2019 code description:

64420 – Injection, anesthetic agent, intercostal nerve, single

64421 – Injection, anesthetic agent, intercostal nerves, multiple, regional block

2020 code description:

▲64420 – Injection, anesthetic agent(s) and/or steroids; intercostal nerve, single level

+▲64421 – Injection, anesthetic agent(s) and/or steroids; intercostal nerves, each additional level (List separately in addition to code for primary procedure)

Note: Code 64421 is now an add-on code and is reported with 64420.

Deleted codes:

The below codes were deleted from the Nervous system in 2020:

64402 Injection, anesthetic agent; facial nerve – to report use CPT code 64999

64410 Injection, anesthetic agent; facial nerve – to report use CPT code 64999

64413 Injection, anesthetic agent; cervical plexus – to report use CPT code 64999

New category III codes: Posterior tibial nerve stimulation (PTNS)

Posterior tibial nerve stimulation (PTNS) is a minimally invasive way to treat urinary incontinence and overactive bladder. The procedure consists of insertion of a percutaneous needle above the medial malleolus into a superficial branch of the posterior tibial nerve to retrain the nerves that control bladder function.

New Category III codes 0587T, 0588T, 0589T, and 0590T have been added to report percutaneous implantation or replacement and revision or removal of integrated single-device neurostimulators with analysis and programming and separate simple or complex electronic analysis of implanted integrated neurostimulator system devices.

Code 0587T:

Description:

Percutaneous implantation or replacement of integrated single device neurostimulation system including electrode array and receiver or pulse generator, including analysis, programming and imaging guidance when performed, posterior tibial nerve

When to report 0587T?

This code is used to report percutaneous implantation or replacement of single-device neurostimulators with analysis and programming. Do not report 0587T in conjunction with 64555, 64566, 64575, 64590, 95970, 95971, 95972, 0588T, 0589T, 0590T.

Key points to remember:

Imaging, programming, and analysis have been included as part of the placement or replacement procedures. Therefore, these services are not separately reported.

Code 0588T:

Description:

Revision or removal of integrated single device neurostimulation system including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve

When to report 0588T?

This code is used to report revision or removal of integrated single-device neurostimulators with analysis and programming. Do not report 0588T in conjunction with 64555, 64566, 64575, 64590, 95970, 95971, 95972, 0587T, 0589T, 0590T.

Key points to remember:

Imaging, programming, and analysis have been included as part of revision or removal procedures. Therefore, these services are not separately reported.

Code 0589T:

Description:

Electronic analysis with simple programming of implanted integrated neurostimulation system (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, posterior tibial nerve, 1-3 parameters

When to report 0589T?

This code is used to report electronic analysis with simple programming services performed independent of placement and revision/removal services. Do not report 0589T in conjunction with 64555, 64566, 64575, 64590, 95970, 95971, 95972, 0587T, 0588T, 0590T.

Code 0590T:

Description:

Electronic analysis with complex programming of implanted integrated neurostimulation system (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, posterior tibial nerve, 4 or more parameters

When to report 0590T?

This code is used to report electronic analysis with complex programming services performed independent of placement and revision/removal services. Do not report 0590T in conjunction with 64555, 64566, 64575, 64590, 95970, 95971, 95972, 0587T, 0588T, 0589T)

Ocular and Auditory Systems

Official studies reveal that the procedure endoscopic cyclophotocoagulation was highly utilized at the same time as cataract surgery. Therefore two new codes 66987 and 66988 were introduced to describe both the endoscopic cyclophotocoagulation and cataract surgery performed in the same surgical session.

Code 66987: (New code in 2020)

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or Phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage, with endoscopic cyclophotocoagulation.

Code 66988: (New code in 2020)

Extracapsular catarct removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or Phacoemulsification), with endoscopic cyclophotocoagulation

Code 66711, 66982 and 66984: (revised code in 2020)

The codes 66711, 66982 and 66984 were revised to include the term “without endoscopic cyclophotocoagulation” in the code description.

▲66711 – Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens

▲66982 – Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg,irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation

▲66984 – Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation

“The content in the above article is valid at the time of posting. It may subject to changes in future years.”

Resources:

https://www.aappublications.org/news/2019/10/30/coding103019

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