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October 3, 2024
Creating Something New: CPT Assigns New Block Codes 

Creating Something New: CPT Assigns New Block Codes 

BY BETHANNE THOMAS, CPC, CPMA, CANPC, CPCO, CPB, CEMC, BHSA, Manager of Coding Compliance, Coronis Health, Jackson, MI 

Creating Something New: CPT Assigns New Block Codes 

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For years, Coronis Health has been advising its clients on the importance of reporting the “unlisted” block code, 64999, to reflect those peripheral block injection procedures that have yet to be assigned a more specific code in the Current Procedural Terminology (CPT) manual. Yes, it’s true that reporting an unlisted code on a claim form does not guarantee payment. Reimbursement may or may not be forthcoming based on the policy or payment system programming of the specific insurance carrier. But reporting the unlisted code is nevertheless important.   

The reason for submitting CPT 64999 in cases where the block administered to treat the patient does not have its own, more particular code is so that utilization for these blocks can be more accurately captured. Typically, when the unlisted code is in play, a hard copy of the claim is sent in, along with the procedure report. That allows the payer to better determine if the procedure meets medical necessity criteria and other policy parameters for payment and, if so, the amount of payment. In calculating the number of times the codeless block is being administered in the real world of medicine, a potential impetus is created among decision-makers at the American Medical Association (AMA)—the main entity that updates the CPT manual—to assign a new CPT code that reflects the particulars of that procedure.  In other words, the idea is to build momentum for code creation. 

A TEAM WIN  

Based on the “proposed” Medicare Physician Fee Schedule (MPFS) for next year, it seems like the wait is over for some common “unlisted” blocks. Starting January 1, 2025, Medicare will reimburse for administering thoracic fascial plain blocks (6XX07-6XX10) and lower extremity fascial plane blocks (6XX11-6XX12) when reported with the newly created Category 1 CPT codes.  

The proposed rule provided a breakdown of the CPT code descriptions with a placeholder X in the actual CPT code. The placeholder will be replaced with an actual number once the CPT codes have been released by the AMA. It should be noted that these new codes do include “imaging guidance when performed”; so, you will not be able to bill for the ultrasound guidance separately. Some of the most common thoracic fascial plane blocks that would start being reported with the new code set 6XX07-6XX10 include the below: 

    • Pectoral I and Pectoral II (PECs I & II)  
    • Serratus anterior plane  
    • Erector spinae plane  
    • Quadratus lumborum  

Some of the most common lower extremity fascial plane blocks include:  

    • Facia iliaca plane  
    • PENG  
    • IPack 

The 2025 MPFS proposed rule also indicates agreement with the work relative value units (RVUs) as recommended by the Relative Value Scale Update Committee (RUC) for this new code set. In addition, based on Table 1, there were some changes to the work RVUs for the existing transversus abdominis plane (TAP) block codes (64486-64489). This reflects a decrease in RVUs from prior years. 

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MAKING A DIFFERENCE  

When a physician performs a new procedure or utilizes new technology, an unlisted code is commonly used 1.75 when no other CPT code adequately describes the procedure or service. The consistent reporting of these services through the submission of “unlisted” codes as provided for in the CPT coding manual can lead to the establishment of new codes. The AMA’s recent action in this regard as it concerns the block procedures that heretofore have not been assigned a code is a testament to the importance of using the unlisted code reporting process that is available within CPT. As a result of utilization review, the AMA and now Medicare will recognize and, in effect, legitimize many block procedures that previously were in question. This, in turn, should lead to more consistent reimbursement relative to these procedures. 

Coronis Health has always advocated for documentation of unlisted CPT codes, as it allows the provider to more accurately summarize services rendered. This will, in turn, ensure the correct reimbursement for not only that particular service, but the entire claim as a whole. The Medicare Physician Fee Schedule for 2025, as proposed, will expand unlisted block codes and be a step toward greater reimbursement for healthcare providers. We can put this one down as a win. 

Bethanne Thomas, CPC, CPMA, CANPC, CPCO, CPB, CEMC, BHSA, serves as Manager of Coding Compliance for Coronis Health. Ms. Thomas has been with Coronis for over eleven years. She is our subject matter expert in the fields of anesthesia and acute/chronic pain management. She also spent time as an adjunct college professor teaching coding for five years which supplements her experience in the medical coding industry. Thomas has a Certified Professional Coder (CPC) designation, as well as being a Certified Professional Medical Auditor (CPMA), a Certified Anesthesia and Pain Management Coder (CANPC), a Certified Evaluation and Management Coder (CEMC), a Certified Professional Biller (CPB), and a Certified Professional Compliance Officer (CPCO), all through the American Academy of Professional Coders. She also possesses a Bachelor Health Services Administration Degree from Baker College. She can be reached at bethanne.thomas@coronishealth.com.