Starting July 1, practices will have a diverse collection of new CPT Category III codes to use for procedures including pulmonary artery denervation, two-chamber leadless pacemaker implant and percutaneous sacroiliac joint fusion.
Among the additions:
- Two codes for pulmonary artery denervation (PADN) – one using ultrasound for the ablation (0632T) and one employing thermal ablation (0793T). Both procedures include right heart catheterization, pulmonary artery angiography and all imaging guidance, according to their descriptions. PADN is an emerging treatment for pulmonary hypertension.
- A Category III add-on code (0791T) for use of motor-cognitive, semi-immersive virtual reality for gait training. The code is to be used with therapeutic gait-training code 97116.
- One new code (0792T) for application of silver diamine fluoride. When applied to the teeth, the treatment helps control or prevent tooth decay.
- A series of codes (0795T-0804T) for leadless, dual-chamber pacemakers, including implant, removal and replacement of one or both of the pulse generators and programming of the system.
- Two new codes (0805T, 0806T) for transcatheter superior and inferior vena cava prosthetic valve implants – also known as caval valve implantation (CAVI). Code 0805T describes a CAVI procedure using a percutaneous femoral vein approach, while code 0806T is reported for an open femoral vein approach.
- A second Category III code (0809T) for percutaneous sacroiliac joint (SIJ) fusion. That means starting July 1, practices will have three different percutaneous SIJ fusion codes to choose from:
- Category I code 27279 for implant of a device “that passes through the ilium, across the sacroiliac joint and into the sacrum, thus transfixing the sacroiliac joint,” the AMA states;
- Category III code 0775T, which took effect this month and describes use of an “intra-articular stabilization device … that does not transfix the sacroiliac joint,” according to the AMA;
- Code 0809T, which describes SIJ using both a transfixation device and intra-articular implant(s).
N.B. Category III codes describe emerging technology procedures that may not yet be FDA approved. Reimbursement can be challenging for the codes, as payers frequently regard the procedures as investigational or experimental. Medicare labels most Category III codes “carrier priced,” leaving it up to the MACs whether to cover them, and if so, to set their own reimbursement rates.
However, CPT coding rules instruct that if a specific Category III code exists to describe a procedure it would not be appropriate to report the service with a Category I code or unlisted code.