Anesthesia Coding Alert

Latest CCI edits also classify plantar injections as comprehensive procedures.

When your anesthesiologist places a Swan-Ganz catheter or arterial line, be sure you aren't reporting those line placements on the same claim as paravertebral facet joint injections. Here's why: The latest Correct Coding Initiative edits (effective April 1) clarify that coding the procedures together is a no-no.

Line Placements Override Paravertebral Injection

Few edits from CCI 17.1 apply directly to anesthesia practitioners, but don't let them slip past your notice. The ones you need to watch focus on three common line placements:

Each of the line placement codes is the comprehensive procedure (or component) when performed during the same patient encounter as injections 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) or 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level).

The edits carry a modifier indicator of "0." Being assigned a modifier indicator "0" means you cannot bypass the bundling edits with a modifier to try and be paid for both codes. If you submit both codes on the same claim, you will receive an automatic denial for the Column 2 code.

Code Plantar Injection Over Certain Other Services

More than 60 edits in CCI 17.1 apply to codes 64455 (Injection[s], anesthetic agent and/or steroid, plantar common digital nerve[s] [e.g., Morton's neuroma]) and 64632 (Destruction by neurolytic agent; plantar common digital nerve).

Edits list the plantar nerve injection or destruction as the comprehensive procedure in the pairs. Check CCI 17.1 for a complete listing, but here are a few codes to watch for:

All of the edits affecting 64455 and 64632 have a modifier indicator of "1," meaning there is the potential to be able to bypass the bundling 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), reminds Marvel J. Hammer, RN, CPC, CCS-P, PCS, ASC-PM, CHCO, owner of MJH Consulting in Denver, Co.