Anesthesia Coding Alert

Checkpoint: Don't assume separate coding for J0670 anymore, either.

The latest Correct Coding Initiative (CCI) edits contain plenty of anesthesia and pain management pairs you should check -- and straight away. They went into effect July 1. CCI 16.2 encompasses 16,843 new edit pairs, according to analyst Frank Cohen, MPA, of MIT Solutions, Inc., in Clearwater, Fla. With 11 percent of all active edits affecting anesthesia procedures, you can't afford to miss any of the changes.

Other Work Includes Paravertebral Facet Injection

Although the current CPT book doesn't include them, you could begin using several new codes for paravertebral facet joint injections in January 2010. Now CCI edits bundle two of the new codes with every anesthesia code (00100-01999) and many nerve destruction procedures. The paravertebral injection codes affected are:

0213T -- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level

0216T -- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level.

Procedures paired with 0213T and 0216T range from 64600 (Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) and  64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) to 64650 (Chemodenervation of eccrine glands; both axillae). Most of the edit pairs carry a "0" modifier indicator, but CCI lists a few with modifier indicator "1." Check the full CCI file to verify whether you can use a modifier to break specific edits.

ME Edits Also Hit 0213T-0218T

Paravertebral facet joint injection codes 0213T-0218T come into play as part of mutually exclusive (ME) edits, as well.

CCI 16.2 pairs each choice with corresponding codes involving fluoroscopy or CT guidance: 64490-64492 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic ...) and 64493-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral ...). Each edit carries a "0" modifier indicator, so you can't use modifier 59 to override the bundling.

Steer Clear of Separate Mepivacaine HCL

Your provider might rely on Mepivacaine HCL for nerve or tendon injections, but you can no longer separately report the medication for some procedures. CCI edits now bundle J0670 (Injection, mepivacaine HCL, per 10 ml) with many common injections such as:

20552 -- Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)

20600 -- Arthrocentesis, aspiration and/or injection; small joint or bursa (e.g., fingers, toes)

64400 -- Injection, anesthetic agent; trigeminal nerve, any division or branch

64490 -- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level.

Good news: CCI 16.2 classifies the J0670 edits with a modifier indicator of "1." When justified, you can report both codes and append modifier 59 (Distinct procedural service) to unbundle the pair.

No-Go for Telehealth Reporting

Anesthesia services include pre- and postoperative visits with the patient. CCI 16.2 clarifies that telehealth consultations and follow-ups fall under standard anesthesia services: the edits bundle  every anesthesia code with G0406-G0408 (Follow up inpatient telehealth consultation ...) and G0425-G0427 (Initial inpatient telehealth consultation ...).

Each edit pair carries a modifier indicator of "0," so you cannot report a modifier to break the bundle and report both services.

CCI 16.2 includes more than 16,800 edits. Check the latest version at www.cms.gov to ensure you correctly report procedures.