Using the correct current procedural terminology (CPT) codes is crucial for documenting — and getting reimbursement for — novel treatments for which there is specific but narrowly defined guidance.
During an August Becker's Hospital Review webinar sponsored by Pacira BioSciences, two experts from medical coding company The Coding Network — Bob Lathrop, director assistant, ambulatory surgery, outpatient surgery and interventional pain coding services, and Dreama Sloan-Kelly, MD, co-director, surgical division and education — discussed best practices in documenting procedures that use Pacira's iovera° treatment for osteoarthritis (OA) pain.
Four key takeaways were:
- Cryoneurolysis is an effective approach to OA pain management. As the mechanism of action underpinning Pacira Biosciences' non-opioid iovera° OA treatment, cryoneurolysis provides immediate long-lasting pain relief by delivering intense cold (up to -88°C) to peripheral nerves, interrupting their ability to transmit pain signals for up to 90 days.
- Iovera° treatments are reimbursed under procedure codes related to cryoneurolysis. The specific CPT codes fall under the "64" family of codes referring to destruction by neurolytic agent. "Reimbursement for the iovera° system is not for the device itself, but for the treatment — destruction by neurolytic agent — which in reimbursement terms is considered a procedure," Mr. Lathrop said.
As per guidance issued by the American Medical Association, the relevant codes for documenting treatment with iovera° are 64640 and 64624, and refer to treating anterior and posterior knee pain, respectively. CPT code 64640 is used for each peripheral nerve treated with iovera°, with up to five nerves that can be billed, while CPT code 64624 covers three genicular nerve branches that must be treated together. Additionally, these codes have reimbursement amounts for professional and facility fees, based on the site of care where the treatment was delivered (hospital, ambulatory surgery center or a physician's office).
The global period for claiming reimbursement under the codes is 10 days, counting as day 1 the date of service plus 10 days, for a total period of 11 days. "Commercial payers may have different policies regarding reimbursement for multiple procedures or global periods, so it's imperative that you check your payer policies on how these periods may apply in your setting," Mr. Lathrop noted. - Clinical documentation must support what is coded and billed. The clinical documentation checklist for providing pain management with iovera° must include common items, such as patient identifying information, date of service, rendering provider and an indications section. It also must include pre-procedure and post-procedure diagnosis, and while many times those diagnoses are the same, in the case of iovera° documenting the latter is key. "Your post-procedure diagnosis is your billable diagnosis. This is the diagnosis that goes on the claim form," Dr. Sloan-Kelly said.
Because of the specificity of the CPT codes associated with cryoneurolysis, it is also critical to document all nerves treated with iovera°, whether ultrasound guidance was used and the patient's response to treatment. - Several similar-looking codes should not be used to report iovera° utilization. Those include CPT code 64999 (unlisted procedure, nervous system) and category III codes 0440T through 0442T, which refer to cryoablation, a similar but distinct procedure from cryoneurolysis.
Note: This webinar included a detailed overview of nerves pertinent to anterior and posterior knee pain, facility and professional services fee schedules for 2022, multiple procedure logic methodology used for iovera° reimbursement, mock claim forms, six illustrative examples and other considerations that surpass the scope of this summary.
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