New CPT Codes – Nervous, Ocular and Auditory Systems

This is Part 4 of a 5-part series on the new 2022 CPT codes.  In this one we will explore the nervous, ocular and auditory systems CPT changes.

Nervous System

Several new codes were created in the nervous system. The first involves LITT:

• 61736 Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; single trajectory for 1 simple lesion
• ►(Do not report 61736, in conjunction with 20660, 61737 61781, 70551, 70552, 70553, 70557, 70558, 70559, 77021, 77022)◄
• 61737 multiple trajectories for multiple or complex lesion(s)
• ►(Do not report 61737 in conjunction with 20660, 61736, 61781, 70551, 70552, 70553, 70557, 70558, 70559, 77021, 77022)◄
• MRI Monitoring is included in these codes and not reported separately.  The patient first undergoes a stereotactic frame, frameless navigation arm or robotic holder placement.   The patient is transported to MRI suite and software is used to target boundary(s) and temperature reference points with thermal mapping of the target area.  Laser energy is delivered as many times as necessary to create the entire lesion.

Codes for cranial nerve stimulator UPDATED.  AMA changed “incision for” to “open” and removed the references to 0466T-0467T.

• ▲ 64568 Incision for Open implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator.     (Do not report 64568 in conjunction with 61885, 61886, 64570)
• 64569 Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator
• ▲64575 Incision for Open implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)
• ▲64580 neuromuscular
• ▲64581 sacral nerve (transforaminal placement)

New codes for hypoglossal Nerve Stimulator insertion and revision:

• 64582 Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array
• 64583 Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to existing pulse generator (both must be replaced/revised to use this code)  ►(For replacement of pulse generator, use 61886)◄
• 64584 Removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array  ►(Do not report 64584 in conjunction with 61888, 64582, 64583 )◄
• The hypoglossal nerve is considered a cranial nerve for which codes exist (eg, codes 61885, 61886, and 61888); however, the work necessary for placing a hypoglossal nerve stimulator system is more extensive. This is because work for hypoglossal nerve placements requires more dissection of the nerve to identify the branches that protrude the tongue.  New codes 64582-84 capture this extra service and total effort. The hypoglossal nerve stimulator is meant to open the airway by moving the tongue forward during sleep. When it is activated, it electrically stimulates the hypoglossal nerve to the tongue. This causes a muscle contraction that brings the tongue forward. https://www.medpagetoday.com/resource-centers/excessive-sleepiness-and-associated-risks-with-obstructive-sleep-apnea/osa-role-hypoglossal-nerve-stimulation/2720

Two new codes have been developed for destruction of basivertebral nerve:

• 64628 Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral
• +64629 each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)

This procedure treats patients with certain types of chronic low back pain.

Craniectomy for implant of neurostimulator electrode or removal of foreign body 61870, 62163 deleted

63194, 63195, 63196, 63198, 63199 deleted (Laminectomy with cordotomy, with section of 1 or 2 spinothalamic tract,

1 stage 2 stage; cervical, thoracic)

New codes were created for laminectomy during posterior interbody fusion. We touched on these when we discussed

the musculoskeletal changes.  The fusion codes that these are used with are below.

• +63052 Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord,

cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis,

lumbar; single vertebral segment (List separately in addition to code for primary procedure)

• 63053 each additional segment (List separately in addition to code for primary procedure)

►(Use 63053 in conjunction with 63052)◄

►(Use 63052, 63053 in conjunction with 22630, 22632, 22633, 22634)◄

• Notes updated under codes 63047-48 to reflect new codes.
• For decompression performed on the same interspace(s) and vertebra; segment(s) as posterior interbody

fusion that includes laminectomy, removal of facets, and/or opening/widening of the foramen for

decompression of nerves or spinal components, such as spinal cord, cauda equina or nerve roots, see 63052,

63053.

Ocular System

A new code was added for anterior segment aqueous drainage device WITHOUT reservoir, to be reported with code 66982 as follows;

• 66982 Extracapsular cataract removal COMPLEX with insertion of intraocular lens prosthesis (1-stage procedure),

►(For complex extracapsular cataract removal with intraocular lens implant and concomitant intraocular aqueous drainage device by internal approach, use 66989)◄

• ●66989 with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior

segment aqueous drainage device, without extraocular reservoir, internal approach, one or more

►(For complex extracapsular cataract removal with intraocular lens implant without concomitant aqueous drainage device, use 66982)◄

►(For insertion of intraocular anterior segment drainage device into the trabecular meshwork without concomitant cataract removal with intraocular lens implant, use 0671T)◄

A new code was added for anterior segment aqueous drainage device WITHOUT reservoir, when done with

extracapsular cataract removal.

• 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical  technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic     cyclophotocoagulation

►(For extracapsular cataract removal  intraocular with concomitant intraocular aqueous drainage device by internal approach, use 66989)◄

•  ●66991 with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior

              segment aqueous drainage device, without extraocular reservoir, internal approach, one or more

►(For extracapsular cataract removal with intraocular lens implant without concomitant aqueous drainage device, use 66984)◄

►(For insertion of intraocular anterior segment drainage device into the trabecular meshwork without concomitant cataract removal with intraocular lens implant, use 0671T)◄

There is a new Category III code for the insertion of the above device WITHOUT concomitant cataract removal”

• 0671T Insertion of anterior segment aqueous drainage device into the trabecular meshwork, without external

reservoir, and without concomitant cataract removal, one or more

►(Do not report 0671T in conjunction with 66989, 66991)◄

►(For complex extracapsular cataract removal with intraocular lens implant without concomitant aqueous

drainage device, use 66982)◄

►(For insertion of anterior segment drainage device into the subconjunctival space, use 0449T)◄

The terms in strikethrough below were removed from the CPT description of these codes to be consistent with other

retinal laser photocoagulation codes:

▲67141 Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or   

 more sessions; cryotherapy, diathermy

▲67145 photocoagulation (laser or xenon arc)

A new code has been created for insertion of a LACRIMAL CANALICULUS drug eluting implant. It treats ocular inflammation and pain following ophthalmic surgery and ocular itching associated with allergic conjunctivitis

• 68841 Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each    (0356T was deleted)

►(For placement of drug-eluting ocular insert under the eyelid[s], see 0444T, 0445T)◄

►(Report drug-eluting implant separately with 99070 or appropriate supply code)◄

A couple more category III codes were added as follows in treating amblyopia:

• 0687T Treatment of amblyopia using an online digital program; device supply, educational set-up, and initial session
• 0688T assessment of patient performance and program data by physician or other qualified health care professional, with report, per calendar month

►(Do not report 0687T, 0688T in conjunction with 92065, when performed on the same day)◄

Amblyopia occurs in 1 to 3% of children and causes reduced vision in one or both eyes, with no significant visible retinal or optic nerve disease.  Commonly associated with refractive error, strabismus, or both.

• 0704T Remote treatment of amblyopia using an eye tracking device; device supply with initial set-up and patient education on use of equipment
• 0705T surveillance center technical support including data transmission with analysis, with a minimum of 18 training hours, each 30 days
• 0706T interpretation and report by physician or other qualified health care professional, per calendar month

Several other Category III codes were added for reporting implantation, removal/reimplantation of an ANTERIOR SEGMENT drug eluting system which is non-biodegradeable and also by internal approach. Performed at surgery, or with needle injecting this material into the front of the iris, or front of the lens, behind the cornea.   This treats diseases such as glaucoma by reducing the intraocular pressure.

• 0660T Implantation of anterior segment intraocular nonbiodegradable drug-eluting system, internal approach  ►(Report medication separately)◄
• 0661T Removal and reimplantation of anterior segment intraocular nonbiodegradable drug-eluting implant  ►(Report medication separately)◄

The anterior segment of the eye includes the cornea, lens, iris, and aqueous. The aqueous is divided into anterior and posterior chambers. The anterior chamber is by far the larger, including all of the aqueous in front of the lens and iris and behind the cornea. The posterior chamber includes the narrow area behind the iris and in front of the peripheral portion of the lens and lens zonules

• 0699T Injection, posterior chamber of eye, medication

Auditory System

The code for implantation of osseointregrated implant has been revised as below.  69715, 69718 were deleted.

▲69714 Implantation, osseointegrated implant, temporal bone skull, with percutaneous attachment to external

  speech processor/cochlear stimulator; without mastoidectomy with percutaneous attachment to external speech

processor

 69715 Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech      

processor/cochlear stimulator; with mastoidectomy

►(69715 has been deleted. To report mastoidectomy performed at the same operative session as osseointegrated

implant placement, revision, replacement, or removal, see 69501-69676 (existing codes))◄

• 69716 with magnetic transcutaneous attachment to external speech processor  THIS IS A NEW CODE

                  #▲69717 Revision or replacement (including removal of existing device), osseointegrated implant, temporal bone

skull, with percutaneous attachment to external speech processor/cochlear stimulator; with percutaneous

attachment to external speech processor without mastoidectomy

69718 Replacement (including removal of existing device), osseointegrated implant, temporal bone, with

percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy

►(69718 has been deleted. To report mastoidectomy performed at the same operative session as osseointegrated

 implant placement, revision, replacement, or removal, see 69501-69676 (existing codes))◄

• 69719   with magnetic transcutaneous attachment to external speech processor
• 69726 Removal, osseointegrated implant, skull; with percutaneous attachment to external speech processor
• 69727   with magnetic transcutaneous attachment to external speech processor

These devices treat hearing loss through surgical placement of an abutment or device into the skull that facilitates

transduction of acoustic energy to be received.  Reporting mastoidectomy separately will help in coding   

                  this accurately. This is a good site to see the implant:

https://www.westchesterhearingcenter.com/services/hearing-solutions/baha-system/

In Part 5 of this series, we will discuss the remaining category III codes, modifiers and Evaluation and Management code for 2022.

The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.