As promised, the following information provides further details for 2023 CPT changes. Be sure to review and share with your practice management team(s) for preparation for January 1st to avoid billing and reimbursement delays.
- Somatic Nerve Injections now bundled with imaging guidance
- New instructions for billing Paravertebral Spinal Nerves & Branches
- New Interventional Radiology Codes
- New US Extremity Nerve Code
- New Category III Codes for CT, MRI & Nuclear Medicine
- Documentation and Coding Tips
The ongoing CMS reviews of CPT code pairs billed together 75% of the time continue to bundle services into one CPT code. The following somatic nerve injection codes will have imaging guidance bundled into the surgical component codes, no longer separately billable, as of January 1, 2023.
As these services are bundled, it becomes even more important specifically document all pertinent information including the imaging (modality) guidance and the exact site of injection.
Read on and take the necessary steps to be ready for the new year.
Interventional Pain Management
Somatic Nerve Injections – What you need to know:
- Imaging Guidance is now included in the codes below
- Do not bill separately for imaging guidance as of 1/1/23
- Describe the imaging modality guidance that was used, as well as the injection site
- Note the changes in Work RVUs (wRVUs) and how this may affect reimbursement
New Paravertebral Facet Joint Injections Coding/Billing Instructions – What you need to know:
- CPT has provided a new chart and billing instructions for modifier 50 on codes 64490 -64495. These codes include CT or flouroscopic (flouro) guidance
- Documentation should clearly identify Uni or Bilaterality for Cervical, Thoracic, Lumbar, or Sacral level of the spine.
Check out the chart below from CPT 2023 to help with coding questions when injecting multiple levels of paravertebral facet joints.
New Interventional Radiology
Pulmonary Artery Revascularization – What you need to know:
- Two different code sets
- Normal Native Connections Unilateral & Bilateral
- Abnormal Connections Unilateral & Bilateral
- Add-on code for each additional vessel or separate lesion(s), normal or abnormal connections
- These codes include vascular US guidance, all catheter & guide wire manipulation, fluoro guidance, any post-diagnostic angios for roadmapping purposes & post-implant evaluation, stent positioning & balloon inflation for stent delivery & RSI of the intervention
- Documentation should specify if unilateral or bilateral
- Documentation should specify if normal native or abnormal connections
Percutaneous Arteriovenous Creation Upper Extremity – What you need to know:
- Two different codes
- Via single access site, 36836. Catheter is passed through vein wall into proximal radial artery (AV fistula). Duplex ultrasound guidance only, no fluoro. Procedures a connection between the artery and vein via thermal energy
- Via two access sites, 36837. Arterial catheter introduced through brachial artery. Venous catheter (w RF electrode) is introduced through UE, guided by fluoro magnets are used to hold the artery and vein together. The RF electrode is the used to create a connection between artery & vein (AV fistula)
- These codes include vascular US guidance, angiography, imaging guidance, & blood flow redirection or maturation techniques (e.g., PTA, coil embolization) performed for fistula creation
- These codes are for the upper extremity only; use an unlisted code for the lower extremity
- These codes may not be billed separately when performed at same operative session, code to the most definitive procedure.
New Radiology
Ultrasound – What you need to know:
- Comprehensive evaluation of a nerve is defined as evaluation of the nerve throughout its course in an extremity. Documentation of the entire course of a nerve throughout an extremity includes the acquisition & permanent archive of cine clips & static images to demonstrate anatomy.
- US extremity of nerve(s) 76883 & US extremity, limited 76882 may not be billed together
- Create new US report template for this code and include language that supports following the nerve throughout the extremity as appropriate
Nuclear Medicine – What you need to know:
Descriptor Changes only to Tumor Localization, SPECT & SPECT/CT; CPTs 78803, 78830-78832, 78831 & 78832.
- The term “acquisitions” has been added to descriptors to address when separately obtained images with different Radiopharmaceuticals, even when obtained on same day & from same anatomic sites.
- This also allows better differentiation when reporting codes, SPECT & SPECT/CT 78831 and 78832
- The term “separate acquisition” was added to 78831 & 78832 to allow separate reporting when single area, same day images are performed for different reasons (g., perfusion versus ventilation for the same lung)
- Concurrently acquired computed tomography (CT) transmission scans may be separately reported when performed with codes 78830 and 78832
- See new Category III code, +0742T, Absolute Quantification Myocardial Blood Flow (AQMBF) below in Category III updates
New Category III Codes
CT & MRI Quantitative Codes imply the data is sent off-site to a Third-Party Vendor. The data is processed and sent back to the facility. This is not the same as 3D/MIPs, but rather in addition to.
CT – What you need to know:
- Two Codes
- 0721T Performed retrospectively on previously acquired images
- +0722T Performed on concurrently acquired images
- Clearly document in the report whether prior images were utilized or if concurrently acquired.
- Document the findings derived from data in the report to support billing for these services.
MRI – What you need to know:
- Two Codes
- 0723T Performed retrospectively on previously acquired MRI, same anatomy, same session
- This code may not be billed with CPTs 74181, 74182, 74183, 76376, 76377 or 0724T
- +0724T Performed with diagnostic MRI, same anatomy, same session
- This code may be billed with CPTs 74181, 74182, 74183 when evaluating same organ, gland, tissue, or target structure
- 0723T Performed retrospectively on previously acquired MRI, same anatomy, same session
- Clearly document in the report whether obtained with or without diagnostic MRI
- Document findings derived from data in the report to support billing for these services.
Nuclear Medicine – What you need to know:
- AQMBF is a new procedure add-on code to detect reduced coronary flow reserve and help identify patients with high-risk coronary artery disease
- AQMBF is an emerging technology that uses different processes, software, imaging cameras and workflow.
- Clearly document the use of this technology in the report
- Describe findings derived from use of this technology
- This code may be billed with CPTs 78451 & 78452
In Conclusion
- Make sure your EHR, coding, and billing teams have the needed updates for success prior to January 1, 2023
- Note documentation changes and update report templates as appropriate
- StreamlineMD is your resource for coding and billing needs, please contact us with your questions
References:
- AMA CPT Symposium 2023 and CPT Professional Edition 2023
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