Anesthesia Coding Alert

TPI and tendon injections override 100+ other procedures.

Now that 2012 is here, it's time to put those new procedure and diagnosis codes to use -- and see which ones are affected by the latest Correct Coding Initiative (CCI) edits. CCI 18.0 effective Jan. 1, 2012, changes how you should report anesthesia services for two new Category III codes and some long-time injection procedures.

Report Anesthesia, Not Neurostim Electrode Array

CCI 18.0 includes 544 edits listing an anesthesia code in Column 1 and 154 edits with anesthesia as the Column 2 component, according to an analysis by Frank Cohen, principal and senior analyst for The Frank Cohen Group, LLC, in Clearwater, Fl.

CPT® 2012 introduces two Category III codes for implantation and/or removal of a trial or permanent percutaneous neurostimulator electrode array:

• 0282T -- Percutaneous or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic, or lumbar; for trial, including removal at the conclusion of trial period
• 0283T -- ... permanent, with implantation of a pulse generator.

CCI 18.0 pairs anesthesia codes with 0282T and 0283T, with an explanation of "Standard preparation/monitoring services for anesthesia." The anesthesia procedure is the Column 1 code of each pair, meaning you'll report the appropriate anesthesia code instead of 0282T or 0283T. All edits carry a modifier indicator of "1," so you might sometimes be able to bypass the edit with a modifier and be paid for both services (such as modifier 59, Distinct procedural service). Be sure you have good documentation supporting the use of both codes before attempting to be paid.

Check Out Changes to Injection Procedures

If your physician administers trigger point, joint, or tendon injections, be sure to scroll further down the CCI edits for some changes affecting those codes:

• Trigger point injection codes 20552 and 20553 are the Column 1 codes with new codes 29582 (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed) and 29584 (... upper arm, forearm, hand, and fingers).
• Joint injection codes 20600, 20605, and 20610 are the Column 1 codes with new procedures 20527 (Injection, enzyme [e.g., collagenase], palmar fascial cord [i.e., Dupuytren's contracture]), 29582, 29583 (Application of multi-layer compression system; upper arm and forearm), and 29584.
• Tendon injection procedures 20526 and 20527 are designated as the Column 1 code for more than 130 edit pairs. The coupled procedures range from abscess aspirations and therapeutic injections to cast applications, venipuncture, and anesthetic injections, to name a few. Sift through the edits to see which ones might apply to your providers.

CCI 18.0 is effective Jan. 1, 2012 until March 31, 2012. Visit the CMS website for a complete look at edit changes (http://www.cms.gov/NationalCorrectCodInitEd/20_Version_Update_Changes.asp#TopOfPage).