New Category III Codes Released for July 1, 2020
It’s important to remember that the creation of a new code does not guarantee coverage for the service.
The American Medical Association (AMA) published changes to the Category III codes that take effect on July 1, 2020. The Category III codes represent emerging technologies and procedures and are updated on a semi-annual basis, which allows for faster creation of new codes. It’s important to remember that the creation of a new code does not guarantee coverage for the service. These codes will be published in the 2021 CPT codebook but are available for review now within Vitalware products. Let’s take a look at these new codes and the procedures they describe.
There are two new codes to describe the insertion (0594T) and the removal (0595T) of an externally controlled intramedullary lengthening device into the humerus. This procedure represents an evolution over standard intramedullary nails that are currently used to correct deformities of the humerus. One of these devices is the FITBONE® System, which utilizes a nail containing an electric motor, that is powered by an induction coil, implanted beneath the skin via a second induction coil placed on the exterior surface. A second device, the PRECICE UNYTE® Nail contains a rare earth magnet affixed to a spindle that rotates in response to external magnets placed externally.
There are also two new codes to describe the insertion (0596T) and the revision (0597T) of a temporary female intraurethral valve-pump. This procedure consists of a catheter-like urethral insert, along with a patient-controlled pump that can draw urine out of the bladder when voiding is desired, and block the flow of urine to maintain continence. The device is designed to be used by women who cannot empty their bladder due to impaired muscle function. One such device is the InFlow™ Device, developed by Vesiflo.
The AMA has also approved two new codes to capture noncontact fluorescence wound imaging for bacterial localization. Specifically, 0598T describes the first anatomic site imaged per session, and 0599T describes each additional site imaged per session. These codes will report point-of-care fluorescence wound imaging that allows for detection of the presence, location, and the load of clinically-significant bacteria in order to provide actionable information to physicians when developing a treatment course for patients. Clinicians may provide this service using the MolecuLight i:X™ device.
Irreversible electroporation is another new and emerging procedure that causes cell death in tumors. The procedure uses non-thermal, high-voltage, low-energy, DC current pulses and has shown promise to overcome problems associated with existing thermal or cryotherapies currently in use. The AMA has created one code for percutaneous ablation (0600T) and a separate code for open ablation (0601T). The NanoKnife™ device is currently in clinical trials as a treatment for pancreatic cancer, and is recruiting for clinical trials as a treatment for multiple other cancers.
July 2020 will also see the introduction of a new code for glomerular filtration rate (GFR) measurement (0602T) as well as a code for monitoring services provided every 24 hours (0603T). Both new codes include sensor placement and administration of a fluorescent pyrazine agent. This new device, which is currently in clinical trials, uses a small device affixed to the patient that monitors light emissions from a tracer agent over time to measure GFR, a key indicator of renal function.
There are three new codes to describe remote optical coherence tomography (OCT) of the retina, including one code to report setup of the equipment (0604T), one code to capture remote surveillance and data analyses each 30 days (0605T), and a third code to report physician review and interpretation of the data each 30 days (0606T). OCT is a non-invasive imaging technique that produces high-resolution images of the retina using light waves and provides a view of each of the retina’s distinct layers, which can then be measured and mapped with this technology. Ophthalmologists already widely use this technology, but this hand-held device would allow patients in remote or rural areas to undergo this valuable diagnostic service, and for physicians to monitor at-risk patients on a routine basis without the need for regular office visits.
Continuous external mobile monitoring of pulmonary fluid, including measurement of radiofrequency-derived data, can be reported on or after July 1, 2020, using 0607T for the setup of the equipment, and 0608T for the analysis of data and transmission of reports to the physician. The Cardio-Pulmonary Stethoscope (CPS) uses radiofrequency signals to measure changes in the amount of water present in the lungs via a “chest patch” sensor and can wirelessly transmit the data to a mobile device for remote patient monitoring.
There are four new codes to report the determination and localization of discogenic pain using magnetic resonance spectroscopy (MRS). This new technology uses existing MR technology and a proprietary software program, the NOCISCAN™ Suite, to conduct MRS exams of lumbar discs. First, the data is acquired using MRS pulse sequences, which are optimized for lumbar discs. This data acquisition will be reported using 0609T. Next, the data is uploaded and transmitted for analysis, which will be reported using 0610T. The next step involves the analysis of the data, including the calculation of ratios for certain combinations of chemicals, resulting in a proprietary score; this step will be reported using 0611T. Finally, the results, along with a report of the findings, are generated; 0612T will be used to capture this component.
New CPT code 0613T describes the percutaneous transcatheter implantation of an interatrial septal shunt device and includes right and left heart catheterization, intracardiac echocardiography, and imaging guidance when those services are performed in conjunction with the shunt implantation. One such device is the InterAtrial Shunt Device (IASD) from Corvia Medical, which creates a very small opening between the left and right atria of the heart, allowing blood to flow from the high-pressure area in the left atrium to the low-pressure area in the right atrium, reducing pressure in the left heart and the lungs.
The AMA has also created CPT code 0614T to capture the removal and replacement of a substernal implantable defibrillator pulse generator to complement the new codes created in January 2020.
Testing for concussions and other traumatic brain injuries has been in the news a lot lately, and the AMA has added a code to report an eye-tracking diagnostic procedure, which aids in the diagnosis of traumatic brain injuries. Specifically, CPT code 0615T may be used to report the EyeBOX® exam, which was launched in January 2019.
Three of the new codes represent iris prosthesis insertion procedures. The first code, 0616T, describes the insertion of an iris prosthesis device without removal or replacement of the intraocular lens (IOL). CPT code 0617T describes iris prosthesis insertion with the removal of the crystalline lens and insertion of an IOL. The insertion of an iris prosthesis with secondary IOL placement, or IOL exchange, will be reported with 0618T. The FDA approved the first artificial iris, the CustomFlex® ArtificialIris in 2018 for use in adults and children with iris defects due to injury, surgical removal, or congenital defect. Also note that a new HCPCS code, C1839, was created in January 2020 and was awarded pass-through status.
The final new code created by the AMA for implementation on July 1, 2020 is 0619T. This code describes cystourethroscopy with anterior prostate commissurotomy and drug delivery, and includes ultrasound and fluoroscopy when used to complete the procedure.
The AMA recognizes that healthcare technology evolves rapidly and has developed the Category III codes to report emerging technology, services, procedures, and service paradigms in an expedient fashion. Although the existence of a CPT code does not guarantee coverage for a particular procedure, it is important that Category III codes be assigned when appropriate to allow for accurate data collection. Category III codes are temporary codes that are designed to be archived five years after creation but may be archived sooner if sufficient data is available. Rest assured that Vitalware will keep you apprised of future coding and reimbursement changes.