AS I SEE IT


CPT Coding Change Modification creates challenges for pain management facilities BY JESSICA EDMISTON AND TAMARA WAGNER


A seemingly small coding change made by the Amer- ican Medical


Association (AMA) recently could mean big overhauls in the way that many ASCs perform and report a pop- ular pain management procedure. This change requires the use of Cur- rent Procedural Terminology (CPT) code 64999 instead of 64633, 64634, 64635 and 64636 for nonthermal facet joint denervation including chemical, low-grade thermal energy (<80 degrees Celsius) or any form of pulsed radio- frequency. Previously, the rule did not identify a specific temperature. In 2012, the AMA created new radiofrequency ablation (RFA) codes for facet joints to require that CPT codes 64633, 64634, 64635 and 64636 be reported per joint, not per nerve. This switch caused a complete change in the way the procedure was reported. While this rule has been well understood and utilized since it was implemented, the AMA’s most recent rule change could dramatically alter how outpatient facilities perform RFA, a minimally invasive procedure used extensively in the US to manage chronic back pain. The AMA recently provided the


following narrative related to this pro- cedure: “Although two nerves


innervate


each facet joint, only one code may be reported for each joint denervated, regardless of the number of nerves treated. Use 64634 or 64636 to report each additional facet joint in a differ- ent level in the same spinal region.


Typically, providers also must indi- cate the temperature of the probe and the duration when documenting these procedures. These two requirements pose significant reimbursement chal- lenges for ASCs since Medicare— which accounts for 20 percent of all US health care expenditures—does not reimburse for unlisted codes. Some private payers disallow pay- ment of unlisted codes, and the AMA allows unlisted codes to be used only once for RFA, regardless of the num- ber of nerves treated. This means a facility may be reimbursed for only a fraction of the work performed to com- plete this high-volume procedure. It is uncertain exactly why the AMA


For neurolytic destruction of the nerves innervating the T12-L1 para- vertebral facet joint, use 64633. Do not report 64633, 64634, 64635


and 64636 for nonthermal facet joint denervation including chemical, low- grade thermal energy (<80 degrees Celsius), or any form of pulsed radio- frequency. To appropriately report any of these modalities, use 64999.” While attempting to craft a uniform


standard, the AMA’s coding change might have inadvertently created clini- cal and reimbursement challenges for ASCs for this common back pain man- agement procedure. The reason: many ASCs utilize equipment that does not reach the now-required 80 degrees Celsius for these procedures. The new AMA guidance requires


providers to report the unlisted code if low-grade thermal energy below the 80-degree Celsius threshold is used.


made this change, and the group did not indicate why publicly. In any event, ASCs must adapt to both meet the new AMA coding standards and maximize reimbursement for RFA procedures. This starts by educating an ASC’s phy- sicians, administrators and business office about the new 80-degree Celsius threshold and the various requirements for complying with payer-specific reimbursement rules and, then, deter- mining what clinical and/or coding changes should be made to meet these new challenges.


Jessica Edmiston is the senior vice president of performance review and Tamara Wagner is the vice president of performance review at National Medical Billing Services in St. Louis, Missouri, www.nationalASCbilling. com. Write them at Jessica.Edmiston@ nationalASCbilling.com and Tamara. Wagner@nationalASCbilling.com.


The advice and opinions expressed in this column are those of the author’s and do not represent official Ambulatory Surgery Center Association policy or opinion. ASC FOCUS APRIL 2016 11


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