Anesthesia Coding Alert

3 anesthesia changes affect your everyday coding

 A recent provider bulletin from UnitedHealthcare (UHC) included some need-to-know updates for anesthesia practices. Check these three areas to be sure your UHC claims follow the carrier's latest guidelines.

1. Rely on Modifier 59 Again  

CPT includes modifier 59 (Distinct procedural service) as a way to help you report -- and receive reimbursement for -- procedures that are separate and distinct from other services performed on the same day (such as administering a pain relief injection after the patient's surgery).
 
UHC has reversed its stance on allowing modifier 59 with 79 procedures your providers might perform on the same day as anesthesia services. Thanks to the change, don't automatically add modifier 59 to some of your most common injections, including:

• 62310-62311 -- Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic; and ... lumbar, sacral (caudal)

• 62318-62319 -- Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic; and ... lumbar, sacral (caudal)

• 64412-64425 -- Various sites for Injection, anesthetic agent to somatic nerves

• 64445-64450 -- Single injection or continuous infusion of anesthetic agent to the sciatic, femoral, lumbar plexus and other peripheral nerves.

 "I think this change is probably because of the number of appeals on this service," says Tammy Reed, CPC, anesthesia coding supervisor for Oklahoma Health Sciences Center in Oklahoma City. "Sometimes there is a tendency to think that anesthesiologists bill inappropriately for post-op pain blocks when they used the block as the mode of anesthesia. This just isn't the case. There are legitimate reasons why physicians place blocks and epidurals for pain management, especially when they're caring for multi-trauma patients and pediatric patients."
 
Bottom line: Check UHC's guidelines before reporting modifier 59 with injections or other services your physicians might provide on the same day as the procedure. Visit www.unitedhealthcareonline.com to see the latest guidelines.
 
2. Resident Supervision Requirements Change

According to previous versions of UHC's resident supervision policy, you could only report modifier GC (This service has been performed in part by a resident under the direction of a teaching physician) for resident services.
 
Now the revised policy states that modifier GC is an "informational" modifier rather than a required anesthesia modifier. Because of this, you must now report modifier GC with the appropriate modifier for the anesthesiologist's service: AA (Anesthesia services performed personally by anesthesiologist) or QK (Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals).
 
Warning: If you fail to include either modifier AA or QK with a claim using modifier GC, UnitedHealthcare will ask you to resubmit the claim.
 
Easy fix: For many coders, implementing this change is as simple as a software adjustment. Some carriers even have their own representative make the change, so you don't even need to reprogram it yourself.
 
"We follow Medicare's medical-directing resident guidelines for all carriers," says Darlene Ogbugadu, CPC, with Northwestern Medical Faculty Foundation in Chicago. "We've found this to be helpful when billing with all our carriers. We actually see fewer rejections for missing modifiers since using this policy."
 
UHC also revised its policy regarding how you should report medical supervision of two residents. Previous guidelines instructed you to report modifier QK with the total anesthesia time for the service, but the carrier reduced the time-based allowance by 50 percent because of modifier QK.
 
The new policy follows CMS guidelines: UHC "will also consider an alternative method for reporting medical supervision of two residents. Medical supervision of two residents can be reported with the modifier AA."
 
Caution: Before reporting resident supervision with AA, remember you can only report the time the anesthesiologist is actually present with each resident. UHC will reimburse the anesthesia service at 100 percent of the time-based allowance.
 
Example: While personally performing a six-hour neurology case with a resident, the anesthesiologist must see to an urgent dilation and curettage (D&C) with another resident. You can't report the cases with modifier AA because the anesthesiologist cannot personally perform two cases at the same time.
 
Option 1: You can report modifiers QK-GC for each case, but that reduces the anesthesiologist's payment by 3 hours and 15 minutes (according to the formula 6 hours minus one-half hour, divided by 2).
 
Option 2: You can bill the anesthesiologist's actual time for each case, assuming you have appropriate documentation. The anesthesiologist can document that he was present for 25 minutes of the 30-minute D&C and 5 hours and 35 minutes of the neurology case. This method of billing means the anesthesiologist loses payment for only 30 minutes of his time. But record keeping for this method is more demanding, and many computer billing systems cannot adapt to this.

3. 'Same Provider' Equals 1 Person

Some carriers consider all services rendered by physicians in the same group and with the same specialty to qualify as the "same provider." UHC's updated policy changes its stance on this issue: Now you cannot report different physicians' services for a patient as the "same provider" -- even if they're in the same group.
 
Example: Dr. A starts a patient's postoperative pain management by placing a lumbar epidural following surgery (62319, Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]). Dr. B checks on the patient the next day while making his rounds. If Dr. B meets the criteria for a separate E/M visit, you can bill it separately instead of considering him the "same provider" as Dr. A.
 
Remember: Most carriers consider preoperative and postoperative visits normally reported with E/M codes 99201-99499 or 0074T (Online evaluation and management service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request, established patient) as part of the anesthesia service when conducted one day before, the same day as or one day after the anesthesia procedure.
 
Each of these policy changes has a different effective date. For more information on the revised policies or to check implementation dates, talk with your UHC representative or visit www.unitedhealthcareonline.com.