Anesthesia Coding Alert

Tip: Be especially watchful of your chemodenervaton coding.

If no one from your practice was able to attend the American Medical Association’s (AMA) annual CPT® and RBRVS Symposium in Chicago Nov. 14-16, it’s not too late to get the news. Read on for highlights from industry experts that could affect anesthesia or pain management coders in 2013.

Cross Your Fingers for Better Payment News

One of the first presentations of the conference was by Kathy Bryant, deputy director of the department of physician services at CMS. She updated attendees on several aspects of the Medicare Physician Fee Schedule (MPFS) for 2013, including the reminder that Medicare rates are scheduled to take a 26.5 percent hit in 2013 unless Congress takes action to avert the cut.

"The President’s budget calls for an aversion of the cut and a permanent fix," she said. "They seem to be working on it, but we haven’t heard yet where it’s going."

Make the Shift to Inclusive Provider Terminology

The most widespread changes throughout CPT® 2013 -- the switch to more inclusive or provider-neutral language -- shouldn’t be difficult for physicians or other providers to put into place.

"The concepts are pretty straightforward," said Richard Duszak, Jr., M.D., an AMA CPT® Editorial Panel member and practicing radiologist. "There’s been an evolution in CPT® for how codes report services by non-physicians."

Result: Hundreds of codes were revised for 2013 to include "provider neutral language." Codes throughout the book have replaced designations of "physician" with "individual" or "qualified health care provider."

Example: The instructional guidelines and descriptor for 99360 (Standby service, requiring prolonged attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG]) no longer specify that the service must be provided by a physician. Instead, the descriptor dropped "physician" from the previous wording of "Physician standby service, requiring prolonged physician attendance …" Guidelines for 2013 state in part, "Code 99360 is used to report physician or other qualified health care professional standby services that are requested by another individual …"

Exception: A few codes retained the "physician" language, such as those related to skilled nursing facility admissions, because regulations require that a physician admit the patient.

"CPT® is not the turf police," Duszak said. "We’re focusing on the services provided and recognize that sometimes professionals other than physicians are qualified to provide some services. As a nationally recognized reporting system, it’s important for CPT® to maintain provider neutrality."

Prepare for Big Chemodenervation Changes

If your providers use chemodenervation for long-term pain management, don’t miss important changes to guidelines and code descriptors.

Chemodenervation guidelines for 2013 are revised to state:

• Chemodenervation codes include the injection of other therapeutic agents, such as corticosteroids.
• Do not report a destruction code when therapies are not destructive to the target nerve.
• Chemodenervation agent reported separately with chemodenervation codes.

Two chemodenervation codes are revised for next year, and a new option is added to the mix:

• 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve, unilateral [e.g., for blepharospasm, hemifacial spasm]) is now a unilateral code. For bilateral procedures, append modifier 50 (Bilateral procedure).
• 64614 (… extremity and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) removes the "s" from "extremity." A new coding note directs you to report 64614 only once per session.
• 64615 (… muscle[s] innervated by facial, trigeminal, cervical spine, and accessory nerves, bilateral [e.g., for chronic migraine]) is new for 2013. You should report 64615 only once per session, and cannot report it in conjunction with 64612, 64613, or 64614.

"There’s going to be gnashing of teeth over the new chemodenervation codes," presenter Gregory L. Barkley, M.D., predicted when referring to new code 64615. "Providers have been used to reporting multiple codes when they treat different nerves during an encounter, but the new code changes that. Providers will take a big hit for that."

Continue Enjoying ERX Incentives

The combination of ERX incentive payments and adjustments will remain in place through 2014. Eligible providers who successfully participate in the program will receive 0.5 percent incentive pay in 2013.

"It’s not much," Bryant acknowledged, "but it’s better than the 1.5 percent reduction adjustment for not successfully participating."