Each year, we review the annual coding changes that are relevant to our specialty. While this year is no exception to that process, the list of codes is slightly out of the ordinary. All the codes are Category III codes, or also commonly known as “T codes,” as they are identified by the CPT® Editorial Panel as “New or Emerging Technologies” and have not met criteria for Category I designation.
Interventional radiology is no stranger to this type of CPT® code due to the innovative nature of our specialty, but it should be noted that, when a CPT® code is given a Category III designation, these codes are not valued by the Relative Value Update Committee (RUC) and are contractor priced. That is, each Medicare administrative contractor (MAC) will determine and set a reimbursement rate for these codes, and variability may exist. The Category III codes follow a certain timeline before they are reevaluated by the CPT® Editorial Panel to determine if criteria are met for Category I designation.
Debulking of intracardiac mass
A single new code has been created (0644T) to describe transcatheter percutaneous removal or debulking of intracardiac vegetations (e.g., endocarditis) or mass(es) (e.g., thrombus) using a suction device. Code 0644T includes the work of percutaneous access, all associated sheath device introduction, manipulation and positioning of guidewires, and selective and nonselective catheterizations, blood vessel dilation, embolic protection if used, percutaneous venous thrombectomy, and closure of the blood vessel by pressure or application of an access vessel arterial closure device.
The insertion and removal of arterial and/or venous cannula(e) and initiation of the extracorporeal circuit (venoarterial or venovenous) for intraoperative reinfusion of aspirated blood is included in the procedure. If prolonged extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) is required at the conclusion of the procedure, then the appropriate ECMO cannula(e) insertion code, removal code and initiation code may be reported in addition to 0644T. If an axillary, femoral or iliac conduit is required to facilitate access of the catheter, the appropriate conduit creation codes may be reported in addition to 0644T. When transcatheter ventricular support is required in conjunction with percutaneous intracardiac mass removal, 0644T may be reported with the appropriate ventricular assist device (VAD) procedure code or balloon pump insertion code. When cardiopulmonary bypass is performed in conjunction with percutaneous intracardiac mass removal, 0644T may be reported with the appropriate add-on code for percutaneous peripheral bypass, open peripheral bypass or central bypass.
- 0644T—Transcatheter removal or debulking of intracardiac mass (e.g., vegetations, thrombus) via suction (e.g., vacuum, aspiration) device, percutaneous approach, with intraoperative reinfusion of aspirated blood, including imaging guidance, when performed
It should be noted that 0644T should only be reported in the setting of debulking an intracardiac vegetation or mass. SIR recommends referring to the AMA CPT® 2022 Professional Edition for the full and complete list of inclusion/exclusion criteria for this code.
Laser ablation of benign thyroid nodule(s)
A new code (0673T) has been established to report thyroid nodule laser ablation. This code describes laser ablation of benign thyroid lesions performed under ultrasound guidance, which is a minimally invasive outpatient procedure, compared to the traditional surgical excision.
- 0673T—Ablation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance
Gastrostomy tube insertion with magnetic gastropexy
A new code (0647T) has been created to describe the insertion of a percutaneous gastrostomy tube using magnetic gastropexy under ultrasound guidance. This code is specific to using this new technology. The currently listed Category I code (49440) should not be used when using this technique.
- 0647T—Insertion of gastrostomy tube, percutaneous, with magnetic gastropexy, under ultrasound guidance, image documentation and report
Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2022/CPT®). It is not comprehensive and does not replace CPT. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the definitions of the CPT descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service. Please refer to 2022 CPT® for full and complete guidelines.
Every reasonable effort has been made to ensure the accuracy of this guide; but SIR and its employees, agents, officers and directors make no representation, warranty or guarantee that the information provided is error-free or that the use of this guide will prevent differences of opinion or disputes with payers. The publication is provided “as is” without warranty of any kind, either expressed or implied, including, but not limited to, implied warranties or merchantability and fitness for a particular purpose. The company will bear no responsibility or liability for the results or consequences of the use of this manual. The ultimate responsibility for correct use of the Medicare and AMA CPT billing coding system lies with the user. SIR assumes no liability, legal, financial or otherwise for physicians or other entities who utilize the information in this guide in a manner inconsistent with the coverage and payment policies of any payers, including but not limited to Medicare or any Medicare contractors, to which the physician or other entity has submitted claims for the reimbursement of services performed by the physician.
