Anesthesia Coding Alert

Report anesthesia service instead of new cath or tube placement codes.

The newest edition of Correct Coding Initiative edits (CCI 17.0) goes into effect Jan. 1, 2011, and clarifies that typical anesthesia includes services described by new catheter and tube placement codes.

New Codes Appear in Non-Mutually Exclusive Pairs

Non-mutually exclusive edits apply to services that a physician might perform during the same care session but that aren't billable together. This is because one of the codes (the component code) is included in the services represented by the second (comprehensive) code of the pairing. You can bill individual components if the physician does not perform the entire comprehensive procedure. But if the physician performs the entire (comprehensive) procedure, you should bill the comprehensive code instead of the individual parts or components.

CCI 17.0 includes non-mutually exclusive edits for virtually every anesthesia code when performed with several new CPT codes. Coding for the anesthesia procedure overrides the following codes when the physician provides both services during the same session:

• 0251T -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe
• 0253T -- Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the suprachoroidal space
• 31634 -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance [eg, fibrin glue], if performed
• 43753 -- Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (e.g., for gastrointestinal hemorrhage), including lavage if performed
• 43754 -- Gastric intubation and aspiration, diagnostic; single specimen (e.g., acid analysis).

The same edits apply to anesthesia during three catheter andcoronary angiography procedures:

• 93451 -- Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed
• 93456 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization
• 93457 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization.

Exceptions: Each edit pair carries a modifier indicator of "1," meaning you can sometimes bypass the edit by filing your claim with an appropriate modifier. Be sure you have enough supporting documentation to justify payment for both codes before filing with a modifier such as 59 (Distinct procedural service).

Forget Subsequent Care With Anesthesia

CPT 2011 introduces three new codes for subsequent observation care (99224-99226, Subsequent observation care, per day, for the evaluation and management of a patient ...). CCI 17.0 clarifies that standard anesthesia care includes services represented by 99224-99226. These edits carry a modifier indicator of "0," which means you cannot report the services with a modifier to try and be paid for both codes. If you submit both codes on the same claim, you'll receive an automatic denial.

FYI: CCI 17.0 includes 698,042 active edit pairs, according to an analysis by Frank Cohen, MPA, MBB, senior analyst for The Frank Cohen Group in Clearwater, Fla. Check the latest version at www.cms.gov to ensure you correctly report procedures.