Last week on the blog, we examined the rare phenomenon of procedure codes whose reimbursements are established “by report.” This occurs when the Physician Fee Schedule fails to provide a reimbursement amount for valid procedure code, allowing providers to essentially set their own price – as long as they can back it up. Today, we’ll take a closer look at one of these codes in particular: CPT Code 0232T for platelet-rich plasma injection.
The DaisyBill support team fields a lot of questions about Procedure Code 0232T, and it’s easy to see why. To start with, it encompasses a number of smaller procedures in addition to the actual injection – including image guidance, bloodwork, and plasma harvesting and preparation. In spite of the fact that some of these procedures have individual codes, any work associated with in-office PRP injections should be reported using code 0232T.
Furthermore, 0232T is a Level III code according to the Current Procedural Terminology, or CPT. The T at the end of the code denotes “temporary,” meaning that 0232T won’t stick around forever. Instead, it’s part of a group of temporary codes used primarily for emerging or experimental procedures and technologies. Usage of these codes is closely monitored by the CPT; eventually, most Level III temporary codes give way to a permanent Level I code with a set reimbursement amount.
On top of its Level III categorization, CPT Code 0232T is also given a Status Code C, meaning that reimbursement for this code is established by report. Codes like this, commonly known as BR codes, require a provider to submit a separate, non-reimbursable report justifying their chosen reimbursement value.
Guidelines for such a report can be found in the California Code of Regulations § 9789.12.4. In general, these reports must:
- Prove “that the service was reasonable and necessary to cure or relieve from the effects of the industrial injury or illness.”
- Describe the procedure in as much detail as possible, including information about
- the length of the procedure,
- any equipment used, and
- the level of expertise or skill needed to perform the procedure. This information should be submitted via a separate, non-reimbursable report.
Unsurprisingly, reimbursements for BR codes are frequently mishandled. Next week, we’ll examine what to do if the reimbursement for CPT Code 0232T is incorrect. We will also analyze the 39 Independent Bill Review (IBR) decisions related to this code. These IBR decisions provide useful insight into the billing requirements necessary to succeed at the highest level of appeal if a code such as this one is reimbursed incorrectly.
Eager to learn more about CPT Codes for workers’ comp? Watch our webinar below – we’ll show you how to bill for non-face-to-face prolonged services such as record review.
[a]link to blog
[b]link to help article