Transcutaneous Magnetic Nerve Stimulation

Question:

How is this service reported, we are having trouble locating a CPT code, should we use an unlisted code?

Answer:

This service should not be reported with an unlisted code.New Category III codes were created in 2023 to report transcutaneous magnetic nerve stimulation of peripheral nerve by focused low frequency electromagnetic pulse with noninvasive electroneurographic localization. This new technology is used in the management of chronic pain following a traumatic injury. The treatment is repeated over several months. Injured nerve is localized using magnetic stimulation at the time of the initial treatment. The skin is marked with photographic record to facilitate rapid localization of the correct site for subsequent treatments and the appropriate amplitude of magnetic stimulation.  

Nerve conduction may be used as guidance to confirm precise localization of the injured nerve but is not separately reported as a diagnostic study. If a separate diagnostic nerve conduction study is performed prior to the decision to treat with transcutaneous magnetic stimulation, then it may be reported separately.  

• 0766T Transcutaneous magnetic stimulation by focused low frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic location (nerve conduction location) when performed; first nerve  

• +0767T Each additional nerve (List separately in addition to code for primary procedure 

*This response is based on the best information available as of 7/11/24.

Platelet Rich Plasma (PRP) Injections

Question:

What codes should we be reporting when we do PRP injections in our office?

Answer:

Code 0232T, Injection (s), platelet rich plasma, any site, with image guidance, harvesting and preparation when performed, is used to report this procedure. A PRP injection is bundled into the tendon sheath, trigger point, and joint injection CPT codes, thus, these codes should not be coded in addition to 0232T. Code 0232T is only reported when it is the only procedure performed. As a Category III code, it is not valued by Medicare (has 0 RVUs assigned), so payment is problematic, and most Medicare carriers do not pay for PRP. Billing a PRP injection as a trigger point injection is a misrepresentation of the actual service provided.

*This response is based on the best information available as of 6/20/24.

Acupuncture

Question:

We are having trouble getting our acupuncture claims paid, can you advise if this is covered per Medicare and other payors? 

Answer:

In general, many payors do not cover acupuncture.  Therefore, it is the patient's responsibility to pay.  Check your payor policies regarding coverage criteria. 

Medicare recently released Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N).  https://www.cms.gov/files/document/mm13288-national-coverage-determination-3033-acupuncture-chronic-low-back-pain.pdf 

CMS will cover acupuncture for chronic low back pain – up to 12 visits in 90 days under the following circumstances: 

• For the purpose of this decision, chronic low back pain (cLBP) is defined as: Lasting 12 weeks or longer; nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease); not associated with surgery; and not associated with pregnancy. 

• An additional eight sessions will be covered for those patients demonstrating an improvement. No more than 20 acupuncture treatments may be administered annually. 

• Treatment must be discontinued if the patient is not improving or is regressing. 

Refer to Medicare’s coverage policy for the type of provider that may furnish the service and for other information. 

*This response is based on the best information available as of 6/6/24.

Moderate Sedation Documentation

Question:

Is use of the nurse flow sheet when billing for moderate sedation with our pain injection procedures allowed?

Answer:

Per CPT coding guidelines, when billing for moderate sedation an independent trained observer is required.  An independent trained observer is an individual who is qualified to monitor the patient during the procedure, who has no other duties (e.g. assisting at surgery) during the procedure. 

Moderate sedation must be documented in the body of the procedure report; a separate flow sheet is not sufficient for the surgeon documentation.  Document “ I personally supervised Mary Brown RN providing 45 minutes of moderate sedation with XX mg Versed and XX mg Fentanyl”. 

*This response is based on the best information available as of 5/23/24.

Painful Spinal Hardware

Question:

Our physician injected 0.5% Marcaine and 80 mg of Depo-Medrol to existing spinal hardware (eg, pedicle screws) at L4, L5, and S1 bilaterally for a patient complaining of painful hardware. Can CPT code 64483 be reported? 

Answer:

No. CPT code 64483, (Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level), represents transforaminal epidural nerve root injection performed in the lumbar region. There is no specific CPT code for the injection of spinal hardware. CPT code 64999, Unlisted procedure, nervous system, would be most appropriate to describe the injections for pain performed outside the foramen, as indicated in the clinical scenario provided in this inquiry. Although three spinal level (L4, L5, S1 bilaterally) injections were performed, code 64999 should be reported only once to represent the multiple injections. 

*This response is based on the best information available as of 5/9/24.

Ganglion Impar Injection

Question:

What is the correct code to report when our physician performs a ganglion impar injection with Depo-Medrol and Lidocaine? 

Answer:

The most appropriate code for this procedure is unlisted. However, as with all pain injections, check your payor policies regarding specific coverage. 

*This response is based on the best information available as of 4/25/24.