Anesthesia Coding Alert

Latest CCI edits weigh in on hypothermia, disallow certain HCPCS codes with joint, somatic nerve injections.

If your anesthesiologist performs controlled hypothermia during neonatal heart surgery cases, only report the anesthesia code, not the "T" code for hypothermia. The hypothermia change (plus edits related to injection procedures) went into effect July 1, thanks to the latest round of Correct Coding Initiative (CCI) edits.

Anesthesia Overrides Hypothermia

Every edit pair related to anesthesia focuses on codes 0260T (Total body systemic hypothermia, per day, in the neonate 28 days of age or younger) and 0261T (Selective head hypothermia, per day, in the neonate 28 days of age or younger).

The edits related to 0260T and 0261T use the explanation "Misuse of column two code with column one code." CCI 17.2 outlines that you should not report neonatal hypothermia codes with the cardiac anesthesia codes:

• 00560 -- Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator
• 00561 -- Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age
• 00562 -- Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, age 1 year or older, for all non-coronary bypass procedures (e.g., valve procedures) or for re-operation for coronary bypass more than 1 month after original operation
• 00563 -- Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator with hypothermic circulatory arrest
• 00566 -- Anesthesia for direct coronary artery bypass grafting; without pump oxygenator
• 00567 -- Anesthesia for direct coronary artery bypass grafting; with pump oxygenator
• 00580 -- Anesthesia for heart transplant or heart/lung transplant.

Note: CPT® includes a qualifying circumstances code you can sometimes report when your anesthesiologist treats patients of extreme age: +99100 (Anesthesia for patient of extreme age, younger than 1 year and older than 70 [List separately in addition to code for primary anesthesia procedure]). Never use +99100 in conjunction with codes that specify patient ages, however, such as 00561.

"The ASA Relative Value Guide has a parenthetical comment that code 00561 takes patient age and hypotension/hypothermia into consideration," explains Tacy Brown, coding specialist with Mountain West Anesthesia in Salt Lake City. "It would not be appropriate to report additional qualifying circumstances codes +99100-99135 in addition to code 00561."

Caveat: Cardiac anesthesia codes that are not age specific and do not specify that the service includes hypothermia might be eligible for qualifying circumstances codes.

Bonus: Each of the hypothermia edits carries a modifier indicator of 1, meaning you can use a modifier to separate these bundles when both services were medically necessary and performed as distinct procedures. Watch for notations in the patient record stating that anesthesia was complicated by utilization of total body hypothermia or a description of the procedure used to lower the patient's body temperature below 35C/95F. Those details will alert you to check whether you can code other procedures with the hypothermia.

Verify if Specialty Treatment Injections Are Allowed

Pain management coders need to also watch some edits involving three HCPCS codes:

• C9800 -- Dermal injection procedure(s) for facial lipodystrophy syndrome (lds) and provision of radiesse or sculptra dermal filler, including all items and supplies
• G0428 -- Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex).

More than 100 edits prevent you from reporting G0428 or C9800 with procedures including joint injections (20600-20610) and epidural injections (62310-62319). The edits also encompass virtually all somatic nerve injections (64400-+64484) and paravertebral facet joint injections (64490-+64495). Because the edits are so extensive and might carry either a modifier indicator of 1 or 0, check the edits yourself before filing your claim.

Information: CCI version 17.2 goes into effect July 1, 2011, and offers 2,367 new edit pairs and deletes 336 bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC. For the complete version of CCI 17.2, visit www.cms.gov/NationalCorrectCodInitEd.