The American Academy of Pain Medicine

2009 Coding for Pain Changes

In This Article:

• New ICD-9-CM Codes are Here!
• CPT Changes for 2009 Revealed
• Therapeutic, Prophylactic, and Diagnostic Injections and Infusions- Codes Renumbered
• Treatment of Morton’s Neuroma - New Codes
• Somatic Nerve Blocks - Revisions
• Prolonged Service Codes - Revised
• Modifier 21 - Deleted
• Common Pain Medicine CPT® Codes

New ICD-9-CM Codes are Here!

By Emily Hill, PA

September 18, 2009 -- The updated ICD-9-CM codes have been released and will be effective for dates of service beginning October 1, 2009. Although there were numerous changes, there were a limited number of changes of significance for the typical Pain Medicine practice.

ICD-9-CM codebooks contain helpful information to assist you in the proper use of the codes. This information is sometimes revised to clarify existing instructions or to communicate new guidelines. Depending on the publisher, there are various types of symbols and conventions that assist in identifying code changes as well as the proper use of ICD codes. These symbols and conventions are listed in the front of most editions along with guidelines developed by the ICD-9-CM Coordination and Maintenance Committee. The Committee is composed of representatives from the National Center for Health Statistics and the Centers for Medicare and Medicaid Services (CMS). Proposals for modifications to ICD-9-CM are considered at public meetings held twice a year. Regardless of the publisher for the particular ICD codebook you use, all materials must adhere to the latest government version.

A summary of all code changes can be found in the front of most versions of ICD-9-CM. Code changes and information on ICD-9 coding can also be found on the CMS website at: www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/. The following changes may be of particular interest to Pain Medicine physicians.

A new code 995.24 (Failed moderate sedation during procedure) was added to the sub-category 995.2 (Other and unspecified adverse effect of drug, medicinal and biological substance (due) to correct medicinal substance properly administered). The code includes sedation identified in the medical record as either moderate or conscious sedation. A new code (V15.80) was also added to the sub-category V15.8 (Other specific personal history presenting hazards to health) to identify persons with a history of failed moderate sedation.

Five new codes were added to the category for encounters for laboratory testing (V72.6) to better identify the reason for laboratory examinations. Code V72.63 (Pre-procedural laboratory examination) was added and should be used to report blood tests prior to treatment or procedures and includes pre-operative laboratory examinations.

New sections were added to the supplementary classification of external causes of injury and poisoning (E codes). E codes are intended to be used to collect data for injury research and evaluation of injury prevention strategies. They are not to be used as principal diagnoses and they are not required by CMS. Guidelines for the use of E codes are included in ICD for those practices or institutions which currently collect such information or plan to do so in the future. The new sections ( E000 and E001-E030) identify the status of the person at the time of the injury (e.g., military, civilian) and the activity of the person seeking health care for the injury or health condition (e.g., walking/running, activities involving ice/snow, dancing, team sports, etc). Codes from these new sections are used in conjunction with other codes in the E series.

Practices should begin reviewing the ICD changes to determine the impact on the practice and any necessary revisions to encounter forms or other practice documents. CPT changes for 2010 will be released soon. Watch for updates on these new codes in the coming weeks.

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CPT Changes for 2009 Revealed

By Emily Hill, PA

The American Medical Association (AMA) has released the 2009 changes to CPT-4 codes. The new codes, editorial revision, and guideline changes are effective January 1, 2009. Physicians and their office staff should review the changes and make the necessary modifications to charge capture forms, EHR (electronic health records) and any "cheat sheets" used in the practice.

When preparing to incorporate the 2009 changes, read the complete code descriptors for new codes and editorial changes to existing codes along with any associated instructions within the CPT-4 manual. The manual contains helpful information to assist in proper use of the codes. This information is sometimes revised to clarify existing instructions or to communicate new guidelines. Changes in text are identified in CPT-4 by the green print and placement of the ►◄ symbol around the text. 

There were only a few changes of significance in CPT-4 2009 for Pain Medicine physicians. The main issues are addressed below.

Therapeutic, Prophylactic, and Diagnostic Injections and Infusions - Codes Renumbered

To assist users in comparing and reporting the infusion services procedures, CPT codes 90760-90779 (therapeutic, prophylactic, and diagnostic injections and infusions) were deleted and renumbered with the same descriptors to 96360-96379. This places these codes in a more convenient location that is in proximity to the chemotherapy and other complex infusion services. 

With this relocation, the guidelines that are applicable to the entire set of infusion and injection codes have been consolidated and placed under a revised subheading that reads "Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration".  The general guidelines applicable to all injection and infusion codes provide instructions for reporting physician and facility services.  CPT also revised the guidelines and subsection titles for therapeutic injection and infusion codes (93665-93679) to differentiate these codes from those reported for complex infusion services (96401-96549).

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Treatment of Morton’s Neuroma - New Codes

Two new codes were created to report the injection of plantar digital nerve and the destruction of the common plantar digital nerve by injection. The codes are as follows:

64455 Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton's neuroma)

64632 Destruction by neurolytic agent; plantar common digital nerve

These services are commonly performed for Morton’s neuroma and are reported for services in the lower extremity only. Code 64455 is reported only once per session regardless of the number of injections provided. Notes have been added following each code to indicate these codes should not be reported together at the same session.

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Somatic Nerve Blocks - Revisions

Codes 64416 (brachial plexus), 64446 (sciatic nerve), 64448 (femoral nerve), and 64449 (lumbar plexus) were revised to eliminate subsequent days of daily management for these codes. The deletion was made primarily due to a change in the predominate site of service for these codes from the inpatient to the outpatient setting. Previously, the descriptors for these codes included the phrase “including daily management for anesthetic agent administration” to reflect the follow-up work that frequently occurred in the inpatient setting. With this change, CMS also changed the global periods for these codes from 10 days to 0 days.

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Prolonged Service Codes - Revised

CPT revised the guidelines to the face-to-face prolonged service codes (99354-99357) to clarify that these services can be reported in addition to Evaluation and Management Services (E/M) and any other service provided at the same session as the E/M service.

Directions were added to instruct the user that prolonged service codes can only be reported in conjunction with E/M codes that have typical times or specific times in the descriptor. The guidelines also reflect CPT’s definitions of face-to-face time for office outpatient services and unit/floor time for hospital based services.

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Modifier 21 - Deleted

CPT deleted Modifier 21 (Prolonged Evaluation and Management Service) and instructs users to report the appropriate prolonged service code for extended patient E/M services.

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Common Pain Medicine CPT® Codes

Click Here to view Common Pain Medicine CPT® Codes

Effective January 1, 2009

(CPT is a registered Trademark of the American Medical Association)
Coding & Reimbursement Committee AAPM

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