Anesthesia Coding Alert

Hint: You’ll see more updates for pain management than anesthesia.

The American Medical Association has announced its final version of additions, deletions, and revisions to codes in CPT^® 2019. You won’t have massive changes to incorporate as an anesthesia coder, but still need to be aware of updates that might apply to some of your cases.

Codes Focus on PICC, Assessments, Chronic Care

CPT^® 2019 will add almost 200 new procedure codes. Here are six that you could find yourself using, particularly if you code for pain management services:

• 36572 – Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age
• 36573 – … age 5 years or older
• 99451 – Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time
• 99452 – Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes
• 99491 – Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.
• 0078U – Pain management (opioid-use disorder) genotyping panel, 16 common variants (ie, ABCB1, COMT, DAT1, DBH, DOR, DRD1, DRD2, DRD4, GABA, GAL, HTR2A, HTTLPR, MTHFR, MUOR, OPRK1, OPRM1), buccal swab or other germline tissue sample, algorithm reported as positive or negative risk of opioid-use disorder.

Three revised codes of interest also apply to PICC insertion or replacement:

• 36568 – Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age
• 36569 – … age 5 years or older
• 36584 – Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement.

Deleted Codes Include Arthrodesis

As with the revisions, there are a few deletions from CPT^® 2019 that you could be interested in if you code for pain management:

• 0195T – Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without instrumentation, with image guidance, includes bone graft when performed; L5-S1 interspace
• 0196T – … L4-L5 interspace (List separately in addition to code for primary procedure).

We don’t have information yet on why these codes will be deleted or what your best coding options will be once the change goes into effect on Jan. 1, 2019. Stay tuned for more information in upcoming issues of Anesthesia Coding Alert.