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AMA Releases New Code for Use During the Public Health Emergency

On September 8, the American Medical Association (AMA) released a new code to report the additional practice expenses incurred during a public health emergency (PHE) that is over and above those usually included in a medical visit or service. The code accounts for the additional supplies, materials, and clinical staff time associated with evaluation, management and procedural services provided during the current PHE. 

 Code 99072 is effective immediately and reads:

Additional supplies, materials, and preparation time required and provided by the physician or other qualified health care professional and/or clinical staff over and above those usually included in an office visit or other service(s), when performed during a nationally declared public health emergency due to respiratory transmitted infectious disease.

This new code is intended to capture the following practice expense activities:

  • Time over what is included in the primary service of clinical staff time (registered nurse [RN]/ licensed practical nurse [LPN]/ medical technical assistant [MTA]) to conduct a pre-visit phone call to screen the patient (symptom check), provide instructions on social distancing during the visit, check patients for symptoms upon arrival, apply and remove PPE, and perform additional cleaning of the examination/procedure/imaging rooms, equipment, and supplies
  • Three surgical masks
  • Cleaning supplies, including additional quantities of hand sanitizer and disinfecting wipes, sprays, and cleansers

The code should only be reported when the service is rendered in a non-facility place of service (POS) setting, such as a physician office, and in an area where the activities are required to lessen the transmission of the respiratory disease. The code should be reported only during a PHE due to a respiratory disease and only for additional items required to provide a safe in-person service. The code is to be reported once per in-person patient encounter regardless of the number of services provided at that encounter.

Currently, there are no relative value units (RVU) assigned to the code. The AMA has sent a request to the Centers for Medicare and Medicaid Services (CMS) to immediately implement the code and to assign practice expense RVUs based on input provided by the AMA. Practices can choose to assign a charge and submit the code to third-party payers however individual payer policies will dictate how the claim will be processed.

A special edition CPT Assistant article addressing this code and an additional COVID related laboratory code can be accessed here

Pain Management Codes Posted

The Coding and Reimbursement Committee has updated the coding information available on the AAPM website. New charts have been posted that include information concerning Medicare’s 2020 Relative Value Units (RVUs) for codes commonly reported by Pain Medicine Physicians. The title page provides links to CMS web pages that provide additional information and outlines the basis for the 2020 reimbursement rates.

The charts are organized according to the type of service (e.g. E/M, injections, radiology) with new and revised codes highlighted. As appropriate, some charts contain information indicating which codes include imaging guidance as well as which codes can be reported with the bilateral modifier. The Relative Value Units in the charts reflect the combined RVUs for physician work, practice expense and professional liability (total RVUs). RVUs in the “facility” column are used to calculate payments in the hospital or other facility setting. RVUs in the “non-facility” column are used for services provided in a physician office.

There is also a separate worksheet that lists all the new and revised codes for 2020. CPT 2020 introduces new codes for genicular and SI injections and makes significant changes to the instructions for reporting all somatic nerve injection codes. These changes are outlined in an AAPM E-News article, dated December 18, 2019.

Access the chart of common pain medicine codes online (login required).

Be Prepared for New and Revised CPT Codes for Somatic Nerve Injections and Destruction

CPT 2020 makes significant changes to the family of codes for Somatic Nerve Injections (CPT 64400-64489). This includes code additions, deletions and revisions to existing codes and the introductory guidelines. New codes are also added to report destruction of the genicular nerves and radiofrequency ablation of the sacroiliac joint.

The guidelines clarify that nerve injection codes are to be reported once per nerve plexus, nerve, or branch regardless of the number of injections performed. CPT also clarifies codes for which image guidance is included vs. those for which it can be separately reported. Imaging guidance can be reported separately for codes 64400-64450 when performed and documented. Imaging guidance is an inherent component in the codes for transforaminal epidural injections (CPT 64479-64484), paravertebral blocks (CPT codes 64461-64463) and TAP blocks (CPT 64486-64489). Imaging guidance is also included in the new codes for 2020 to describe genicular and sacroiliac injections and destruction. An instructional table is added to CPT that explains the number of units that can be billed for each code and if imaging guidance is included in the code descriptor.

The parent code for somatic nerve injections is revised by adding an (s) to clarify that multiple injections are included in the codes. It reads: Injection(s), anesthetic agent(s) and/or steroid. Codes 64402, 64410 and 64413 (injection of facial, phrenic, and cervical plexus) are deleted since they are rarely performed. If performed, CPT indicates that the unlisted code 64499 should be reported.

The existing code for injection of the intercostal nerve (CPT 64421) has been changed to an add-on code to report each additional level of intercostal nerve injections and is billed in conjunction with 64420. These codes now read:

64420: Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level

+64421: intercostal nerve, each additional level (List separately in addition to code for primary procedure

A new code (CPT 64451) has been added to describe injection(s) into nerves innervating the sacroiliac joint (SI) and includes fluoroscopy or CT guidance. If performed using ultrasound guidance, the unlisted code 76999 should be reported. There are also exclusionary notes instructing users not to report these services in conjunction with codes that describe paravertebral facet joint injections (CPT 64493-64495), radiological guidance (CPT 77002, 77003, 77012) or guidance codes for chemodenervation (CPT 95873, 95874). Since this service can be performed bilaterally, the instructions indicate that modifier 50 should be appended when performed bilaterally.

There is a corresponding new code (CPT 64625) to describe radiofrequency ablation of the SI nerves and includes imaging guidance. Parenthetical instructions prohibit it from being reported with destruction of lumbar or sacral facet joint (CPT 64635), radiological guidance (CPT 77002, 77003, 77012) or guidance codes for chemodenervation (CPT 95873, 95874). It can be reported with modifier 50 when bilateral procedures are performed.

There is also a new code (CPT 64454) for injection of the genicular nerves. The parenthetical notes state the code requires injection of all nerve branches to include superolateral, superomedial, and inferomedial. If all three nerve branches are not injected, then modifier 52 (reduced services) should be appended to code 64454. Only one unit of service should be reported. The notes also clarify that the codes should not be reported in conjunction with the new code 64624 that describes destruction of these nerves.

Code 64624 is added to describe destruction of the genicular nerve branches. Like the injection code, it requires destruction of three nerve branches, includes imaging guidance and should only be reported with one unit of service. It should not be reported in conjunction with the injection code (CPT 64451) and modifier 52 should be appended if all nerve branches are not destroyed.

Below are the descriptors for new genicular and sacroiliac codes. The CPT book should be consulted for all the parenthetical and introductory guidelines.

CPT Code

     CPT Descriptor

64451

     Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (i.e. fluoroscopy or computed tomography)

64625

     Radiofrequency ablation, nerves innervating the sacroiliac joint, with imaging guidance (i.e. fluoroscopy or computed tomography)

64454

     Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance when performed

64624

     Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed

The new codes are effective January 1, 2020. CPT instructs that the code most specific for the service provided should be used. Therefore, it would not be appropriate to report any other CPT codes to describe the above procedures including codes used in prior years. It is important to make sure that all physicians, other providers and staff are aware of the new changes to avoid denials and/or payer reviews. 

Get Ready for 2020: AAPM’s Coding Webinar on Wednesday, December 11 at 2 pm CT

Don’t miss out on valuable coding and reimbursement information needed for success in 2020. AAPM is hosting a webinar on Wednesday, December 11 at 2PM CT that will discuss new and revised CPT codes effective January 1, 2020, and Medicare initiatives important to your practice.  

The webinar will discuss the 2020 changes to the somatic nerve injection codes and the new injection and destruction codes for genicular and sacroiliac nerves. The webinar will also provide a look ahead to the changes in outpatient Evaluation and Management codes and the new approach to the CMS Merit-based Incentive Payment System (MIPS) both beginning in 2021.

There’s still time to register for the webinar and if you are unable to attend live, you can benefit from registering. All webinar registrants will receive access to a full recording in the AAPM Education Center following the course. Learn more and to register.

Understanding CPT, RUC and the 2020 Proposed Rule

This article provides additional information on the background and processes used to value services in the Proposed Rule for the 2020 Physician Fee Schedule, including the advocacy efforts with CMS and RUC by AAPM and other specialty societies representing pain medicine physicians. The Proposed Rule recommends values for intrathecal/epidural pump procedures (CPT codes 62367-62370), the new codes for injection and ablation of genicular nerves (temporary CPT 64XX0 and 64XX1) and sacroiliac joint (temporary CPT 6XX00 and 6XX01), and somatic nerve injections (CPT codes 64405, 64418, 64420, 64421, 64425, 64430, and 64450). The article also reviews the issues surrounding the other services addressed in the Proposed Rule. 

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American Academy of Pain Medicine