Wednesday, April 14, 2021

Category III Codes

This month “Spotlight on CPT” is going to explore Category III codes.  Located in the CPT Manual following the Category I Medicine Section and then Category II codes, Category III codes are provided as temporary codes.  These codes provide a mechanism for tracking data on services/procedures instead of an unlisted code being assigned.  In fact, if a Category III code exists for a procedure or service then it must be assigned rather than an unlisted Category I code.    

It’s important to note that Category III codes by virtue of their unique status as emerging technologies or procedures/services cannot meet the criteria for Category I code designation.  Those criteria require that a procedure is performed by many providers throughout the country and that if required, FDA approval has been received.  Therefore, utilization of Category III codes provides a method for capturing data on new services/procedures/emerging technology utilization as well as clinical efficacy and outcomes aiding in development of healthcare policies.

Category III codes are alphanumeric consisting of five characters, the first four of which are digits with the fifth character being the letter T.  These codes are archived after five years at which time they will either be converted to a Category I code or removed.  If the Category III code is removed, the procedure or service that had been reported using the retired code must be reported with a Category I unlisted code unless further guidance is provided.  Each Category III code’s sunset date is noted following the procedure description. 

The American Medical Association’s CPT website releases semi-annual updates for new or revised Category III codes.  The full Category III code set is published annually in the CPT Manual and in appendix B, coding professionals can find the list of additions, revisions, and deletions applicable to these codes.  The same coding steps apply for assigning Category III codes as for assigning Category I codes.  Coding professionals should begin in the Index identifying either the surgical procedure or service, the organ or anatomical site, the condition being treated, or applicable synonyms, eponyms, or abbreviations.  Then proceed to review the code(s) provided in the appropriate CPT section and examine the full definitions found. 

An example would be coding for a revision of a cervical disc arthroplasty (two discs).  By reviewing the Index under the procedure Arthroplasty, Intervertebral Disc, Cervical, Revision, two codes are found, 22861 and 0098T.  22861 is for a single level revision with a note that indicates additional level revisions should be assigned to 0098T which is an add-on code.  Both codes would be assigned for the example provided above.

As with all codes it is important to review the Category III code updates when they are released.  Coding professionals can monitor procedures/services performed at their facilities against the code changes.  For example, in the 2020 updates a new code, 0581T (Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral) was implemented.  As with all coding, it is important to review the notes associated with the code.  For this code, two notes shed further light on coding.  The first indicates that this code can only be assigned once per breast.  The rationale is that the ablation could be done on one or more tumors [see tumor(s) in the definition].  The other note refers coders to code 19105 if the procedure performed is a cryoablation of breast fibroadenoma(s). 

Another new Category III code for 2020 is 0582T (Transurethral ablation of malignant prostate tissue by high-energy water vapor thermotherapy, including intraoperative imaging and needle guidance).  Again, a note with the code directs coding professionals to code 53854 if the destruction of prostate tissue is done for benign prostatic hypertrophy.

Category III codes provide vital information as providers, insurers, policymakers, and researchers look to gather data and review outcomes of these new services/procedures.  As coding professionals, it is our responsibility to ensure that they are assigned appropriately following established CPT Coding guidance.

Now, light has been shed on coding Category III codes.


About the Author 
Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.