Pain Management Medical Coding Update: Code 99358 Is No Longer Just an Add-On Code


Here are some of the 2010 pain management E and M coding changes and more. There is another E/M code that was actually modified. These are prolonged E/M services that in the past, it used to be non-direct. The descriptors have changed to before and/or after direct. The key thing here is that code 99358 prior to 2010 was an add-on code. It could only be billed in addition to a valid E/M service. It could never be billed on its own.

And so number one, that is now a parent code on its own. It's no longer an add-on code as far a pain management E and M coding is concerned. So it can be reported. And we have a section guideline that says it may be reported on a different date. However, the key thing that primary service must, this prolonged service must relate to a service or patient where that direct face-to-face patient care has occurred or will occur.

So we can't just have this prolonged E/M service that's out there hanging by itself. We can't report it in December and our doctor is never going to see this patient ever. Or the doctor has not seen this patient since July and we don't have any expectation that the doctor is going to see this patient until we'll say maybe March or next year.

Again, we have a requirement that it needs to be associated with it. It's just that we can now report this code on a different date of service than that face to face service. Again, these codes are non-covered by Medicare. Some of our commercials follow suit. But just to be aware that 99358, it is no longer an add-on code.

Now lets talk about the surgery sections. The first to have changes – and for those of you that have docs that do vertebroplasties, our change is that we have bull's eyes in front of those codes now. And what that means is now for vertebroplasties, any moderate sedation is now included in evaluation of those codes and not separately reported.

These codes will also be under the list in Appendix G indicating that moderate sedation services by the performing surgeon are now included in. So we're no longer going to be able to report the 99144 through 99145, moderate sedation services.

Note, we did not get the changes for kyphoplasty. So, moderate sedations services for kyphoplasty are still separately billable, it's just for the vertebroplasties that are not.

Our next codes jump up into the nervous section. We've had two new codes that are created for the removal and two new codes that are created for the revision. And so, we have a code for removal of a percutaneous lead and a removal of a lead that was (sliced) versus laminotomy/laminectomy. Those are the plate panels.

Likewise, we have a revision code, 63663, for a percutaneous electrode array. And we have a revision including replacement when performed as a plate paddle. So the key things to remember here is that we separation now for those removal codes and then we're breaking that out according to the type of spinal cord electrode lead.

Is that an array that has been inserted percutaneously or was this a plate paddle that was originally placed versus a laminotomy/laminectomy? Correspondingly, the percutaneous codes carry 10-day global period whereas the plate paddle codes continue to carry the 90-day global.

We are not to report that medical coding and billing options 63661 or 63663. That's the removal or the revision including replacement of the percutaneous when we are taking out or replacing a temporarily percutaneously placed array.

So, we cannot - they very clearly states now that we cannot bill for the removal of those trial leads. We cannot bill for the replacement. We can bill for a new lead placement but we cannot bill for that revision/replacement if we are pulling that lead out from a trial stance. It's very clear now for appropriate medical coding and billing.

Likewise, we're getting the clarification that we can't bill the revision in conjunction with the removal because that - where replacement is there, the replacement includes pulling out that lead and putting a new one in. So, we're not going to separately report the removal code if we are doing a replacement.

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