Anesthesia Coding Alert

If you're stumped by what 2008 CPT and Crosswalk updates mean for your spinal instrumentation coding, you're in good company. But help is here. Our anesthesiology insiders reveal how these changes really affect your claims.

CPT 2008 designated the spinal instrumentation codes 22840-22848 and 22851 as add-on codes, which has caused a lot of confusion for anesthesia coders, says Debbie Farmer, CPC, ACS-AN, coder with Auditing for Compliance & Education Inc. in Leawood, Kan.

Here's why: In the ASA Crosswalk, the primary surgical procedures that the spinal instrumentation codes "add-on" to -- such as arthrodesis codes 22532-22819 -- do not cross to the code you're accustomed to using, usually 00670 (Anesthesia for extensive spine and spinal cord procedures [e.g., spinal instrumentation or vascular procedures]). Instead, the primary surgical CPT codes cross to anesthesia codes with fewer base units than 00670, such as 00600 (Anesthesia for procedures on cervical spine and cord; not otherwise specified). Many coders have been worried this means lower reimbursement.

Good news: You should use 00670, despite the fact that it is no longer crossed to a primary procedure code, Farmer says. ASA coding guidelines state, "Only the anesthesia code with the highest base unit value is reported." Here's what you need to know.

The rule: "Add-on codes are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code," according to CPT.

"If you look at +22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation] [list separately in addition to code for primary procedure]) in CPT, it is an add-on code, as are the other spinal instrumentation codes," says Kay Brown, CPC, with Bayou Anesthesia and Pain-in Spring, Texas.--

Example: Because 22840 is now an add-on code, surgical coders may not report the code by itself on a claim. They must report it with a primary procedure, such as 22532 (Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace [other than for decompression]; thoracic).

Pitfall: Typically, you use the anesthesia code that crosses to a primary procedure rather than a code that crosses to an add-on procedure. Some coders may not look to the add-on codes because they're used to the Crosswalk telling them to go to the primary code, Farmer says. But you can't assume this is always the right thing to do.

Instead of instructing you to go directly to the primary code, a new Crosswalk instruction allows you to code from the add-on codes, 22840-22851.

The Crosswalk will tell you whether an add-on-code is appropriate to use, Farmer says.

Example: You'll see an italicized statement under some codes that reads, "This add-on code substantially increases the complexity of the anesthesia care," she says.

If you code for a procedure that merits 22554 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; cervical below C2) and 22840, you would find that the primary code only crosses to 00600 in the Crosswalk.

Code 00600, which is attached to the primary code, has a base 10 value. However, the add-on code crosses to 00670, which carries 13 base units. If you don't search for the instrumentation code in the Crosswalk, you would underreport your anesthesia provider's services by 3 units.

Lesson learned: If you "do not understand this concept and are conditioned to code only to the primary rather than the add-ons, there is a five-unit loss in revenue for lumbar procedure and a three-unit loss in revenue in cervical procedures," Farmer says.

Code 00670 saw a reimbursement boost with Medicare's increased conversion factor, and you don't want to lose it, Farmer says. Correct coding is your first line of defense.

But you may encounter insurance companies that will not accept the anesthesia code.-In these instances, Farmer recommends indicating the cross code -- 00670 -- in field 19 or its electronic equivalent, using the base of 13.-

You may have to appeal your claim, too, Farmer says.-She recommends advising posting personnel to watch for correct payment if your office doesn't generate a report identifying underpayments.

One final piece of advice: Remember that the CPT manual, ASA Crosswalk and ASA Relative Value Guide (RVG) are intended to be used together for coding anesthesia-related services. Exclusive use of one manual can easily result in incorrect coding; always use the information in one to supplement the information in the other two volumes, and always check with your carriers regarding how their individual policies may affect your coding for specific anesthesia procedures.