AMA}E
A M ERI C A I \ ' ? E
'
x:5&iFfih
August,2006
Laxmaiah Manchikanti, MD
American Societyof InterventionalPain Physicians
2831 Lone Oak Road
Paducah,KY 42003
Re:
Category III code 0027T Endoscopic lysis of epidural adhesionswith direct
visualization using mechanical means (eg, spinal endoscopiccatheter system) or
solution injection (eg, normal saline) including radiologic localization and
epidurography
Dear Doctor Manchikanti:
This letter is to notify you that CPT CategoryIII code0027TEndoscopiclysisof epidural
adhesionswith direct visualization using mechanicalmeans (eg, spinal endoscopiccatheter
system)or solution injection (eg, normal saline) including radiologic localization and
epidurographywill expireDecember 31, 2008. According to the CPT process,CategoryIII
codesare archived5 yearsfrom the dateof publicationof the CPT codebook,if the codehasnot
beenacceptedfor placementin the CategoryI sectionof CPT. It is importantto note that the
publicationdateis the datethe informationis printed in the CPT codebook.not the dateit
appearson the AMA Web site.
CategoryIII codesare designatedas a temporarycode for emergingtechnology,services,and
The
procedures.CategoryIII codesallow datacollectionfor theseservices/procedures.
Editorial Panelbelievesthis activity is critically importantin the evaluationof health care
delivery and the formation of public and private policy. The use of thesecodesallow physicians
and health
and other qualified healthcareprofessionals,insurers,health servicesresearchers,
policy expertsto identify emergingtechnology,services,and procedurefor clinical efficacy,
utilization and outcomes.
For thesereasons,you are encouragedto submit a requestvia a Code ChangeRequestform.
You may wish to requestconversionof CategoryIII code 0027TEndoscopiclysisof epidural
adhesionswith direct visualizationusing mechanicalmeans(eg,spinal endoscopiccatheter
system)or solution injection (eg, normal saline) including radiologic localization and
epidurography to a Category I code or you may wish to requestan extension of this code as a
CategoryIII code.
When requestingan extensionof Category III status,you must provide rationale to demonstrate
the continuedneed for a Category III code and list the Category I criteria that the code in
questiondoesnot meet for conversionto a CategoryI code.You may also want to provide an
explanationof your efforts to satisfy this criteria.
Approval by the Panel for extensionof the Category III statuswill be for five years. At that time
it may be possibleto submit a requestfor further extension. In the eventthat the extensionis
requestedby a different party than the original sponsor,subsequentnotifications of expiration
will be sent to the party that sponsoredthe extension.
As part of the requestfor conversionto CategoryI, you may indicateif conversionto CategoryI
statusis not approvedby the Editorial Panel,a preferencefor the CategoryIII code to be
extendedor sun downed.
A requestfor conversionor extensionmust include informationwhich justifies inclusion in
eithercode set accordingto the criteria definedfor the CategoryI and CategoryIII codes. For
your convenience,the criteria for CategoryI and III CPT codesis provided:
CategoryI CPT codes
CategoryI CPT codesdescribea procedureor serviceidentified with a five-digit CPT code and
descriptornomenclature.The inclusion of a descriptorand its associatedspecific five-digit
identifying code numberin this categoryof CPT codesis generallybasedupon the procedure
being consistentwith contemporarymedicalpracticeand being performedby many physiciansin
clinical practicein multiple locations. Additionally, the Editorial Panelrequire:
o
that the service/procedurehas received approval from the Food and Drug Administration
(FDA) for the specificuse of devicesor drugs;
o
is a distinct serviceperformedby many
that the suggestedprocedure/service
acrossthe United States;
physicians/practitioners
o
is well establishedand documentedin U.S.
that the clinical efficacy of the service/procedure
peerreview literature;
of an existing
is neithera fragmentation
service/procedure
thatthesuggested
by oneor moreexistingcode;and
nor currentlyreportable
procedure/service
asa meansto reportextraordinary
is not requested
service/procedure
thatthe suggested
procedures/services
thatalreadyhavea specific
a
performance
of
relatedto the
circumstances
CPTcode.
CategoryIII CPT Codes
As statedabove,CategoryIII CPT codesarea temporarysetof trackingcodesfor new and
the following criteriafor evaluation
emergingtechnologies.The EditorialPanelhasestablished
CategoryIII coderequests.
o
a
A protocol for a study of proceduresbeing performed;
Support from the specialtieswho would use the procedure
Availability of U.S. peer reviewedliterature;
Descriptionsof currentUnited Statestrials outlining the efficacy of the procedure
in theCPT2009publicationcycle,you havethe
In orderto be includedfor consideration
- November8, 2006,March 7,2007,July 11,
possible
proposal
deadlines
opportunityof four
2007,or November7,2007.
Codechangerequestforms areavailableat the AMA/CPT websitehtttp://www.amaor needadditionalinformation,
If youhavequestions
assn.org/amalpublcategory/3866.htm1.
sn.org.
contactMarie Mindemanat 3 12.464.442| or marie.mindeman@ama-as
Thankyou for your interestin CPT.
Sincerely,
MarieMindeman
andDevelopment
Director,CPTResearch
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addressed
of all or partof this information),withouttheexpresswrittenpermissionof theAmericanMedicalAssociation(AMA), is strictly
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Informationprovidedby theAMA doesnot constituteclinicaladvicenor doesit dictatea payor'sreimbursement
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thepractitionerperforminga procedureis responsible
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