Coding, Classification & Reimbursement

Iovera billing: 64640 vs. 0440T-0042T

  • 1.  Iovera billing: 64640 vs. 0440T-0042T

    Posted 12-11-2018 07:17

    There is new therapy the Orthopedic providers would like to use.  It is called Iovera (Non-Opioid nerve block).  It is the temporary destruction of the nerve with cryotherapy.   The Drug company has advised the providers to bill 64640.  However, this clearly states the destruction of the nerve with heat.  Wouldn't the following Category III codes to be the better choice:

    0440T-

    Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve

    0041T-

    Ablation, percutaneous, cryoablation, includes imaging guidance; lower extremity distal/peripheral nerve

    0042T

    Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve (eg, brachial plexus, pudendal nerve)


    Much appreciated.
    Srdjan

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    Srdjan Perisic
    Director, Compliance Operations
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  • 2.  RE: Iovera billing: 64640 vs. 0440T-0042T

    Posted 02-08-2019 12:58
    Hello, Srdjan,

    Our hospital is looking into using Iovera in our Orthopedic clinics. The Iovera recommended code 64640 may not be valid as per your assessment. I thought about the Cat. III codes, but we will perform without image guidance, which is included in code 0441T. The last code that I am considering is the unlisted code 64999 because the CPT guidelines state in the CPT book 2019 page438, "Do not report a code labeled as destruction when using therapies that are not destructive of the target nerve (e.g. pulsed radiofrequency", use 64999."

    Any thoughts?

    Kindly,

    KathyJ. Washburn, CPC




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    Kathy Washburn
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  • 3.  RE: Iovera billing: 64640 vs. 0440T-0042T

    Posted 02-11-2019 07:06
    ​Iovera is not a cryoablation, it is a cryoanalgesia.  Therefore, we follow the CPT Assistant below and use the CPT code 64640 for each nerve.


     

    Cryoanalgesia, correct reporting

    CPT Assistant, October 2017 Page: 9 Category: Frequently Asked Questions

    Related Information

    Surgery: Nervous System

    Question:

    What is the appropriate code to report cryoanalgesia applied to peripheral nerves (ie, genicular), as well as cryoanalgesia for postthoracotomy pain?

    Answer:

    These services are reported the same way as other neurolytic destruction procedures, ie, depending on the anatomical location of the nerve(s) to be treated (eg, code 64630, Destruction by neurolytic agent; pudendal nerve; code 64632, Destruction by neurolytic agent; plantar common digital nerve; code 64640, Destruction by neurolytic agent; other peripheral nerve or branch).



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    Raquel Joubert
    Coding Manager
    East Jefferson General Hospital
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  • 4.  RE: Iovera billing: 64640 vs. 0440T-0042T

    Posted 02-11-2019 09:16
    Good morning, Robert, 

    Thank you for your response. Code 64640 for each nerve was my recommendation to our providers. 

    Have a great day.

    Kathy J. Washburn, CPC

    Coding & Documentation Improvement Specialist

    Marshall Medical Center
    1100 Marshall Way | Placerville, CA | 95667
    Office:  530.626.2825 Ext. 2825

    Fax: 530-626-2869
    kwashburn@marshallmedical.org


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