Don’t Be Confused By Parenthetical Notes

By Pamela Linton, CPC, CANPC, Corporate Coding Manager – Anesthesia and Pain Management

Every year when CPT releases their upcoming changes they often add or modify parenthetical notes which are additional instructions on how to use a code. 2019 is no exception. Not all CPT codes have parenthetical notes, but for those that do, the additional information can be extremely helpful.

One of the main points of emphasis seems to be for ultrasound guidance. We all know that in order to report ultrasound guidance, you must document the localization process and save an image that can be retrieved. So, what about those codes where imaging is bundled into the procedure, such as TAP blocks and the paravertebral blocks that we routinely use for acute post-operative pain management?

Below are the instructions that will be included in the 2019 CPT book under the Surgery guidelines. The pain block codes fall under this category.

“When imaging guidance or imaging supervision and interpretation is included in a surgical procedure, guidelines for image documentation and report, included in the guidelines for Radiology (Including Nuclear Medicine and Diagnostic Ultrasound), will apply.”

This means that even though the imaging may be bundled into some CPT codes and there is no separate reimbursement for the service, the same guidelines for documentation and image retrieval still apply. Keep in mind for procedures where imaging guidance is required to perform the procedure such as a transforaminal injection or a facet joint injection, failure to document the localization process and save the image could be the difference between a billable and non-billable service. This applies to all types of imaging which includes ultrasound and fluoroscopy.