Anesthesia Coding Alert

Pain management changes are widespread, but easy.

The most recent Correct Coding Initiative (CCI) edits went into effect Oct. 1, 2012, with hundreds involving some of the most common injection procedures for pain management specialists. The good news for pain management coders is that putting the edits into practice will be simple when you focus on a few key areas.

Choose Injection Over Skin Repair

If a physician administers a pain management injection in conjunction with a skin repair, in most cases you should automatically submit only the injection code, not the repair. CCI version 18.3 lists the following injection procedures as the Column 1 codes of edit pairs:

• Neurolytic injection procedures (62280-62282)
• Injection procedures for discography (62290 and 62291)
• Neurolytic agent destruction of the trigeminal nerve (64600, 64605, and 64610)
• Chemodenervation (64611-64632)
• Neurolytic destruction of paravertebral facet joint nerves (64633 and 64635)
• Other neurolytic destruction and chemodenervation procedures (64640, 64650, 64653, 64680, and 64681).

Each edit pertaining to these injections applies to virtually every simple, intermediate, and complex repair code (12001-13153). However, the edits do not include a few codes from both coding groups (injections and repairs).

Example 1: The Column 1 codes do not list +64634 (Destruction by neurolytic agent, paravertebral facet joint nerve[s] with imaging guidance [fluoroscopy or CT]; cervical or thoracic, each additional facet joint [list separately in addition to code for primary procedure]) with the other paravertebral facet joint destruction procedures. Look closely, though, because not seeing +64634 on the CCI list doesn't automatically mean you can report it in conjunction with some skin repair procedures. Code +64634 is an add-on code to the parent code 64633. The edits do apply to 64633, which makes them also apply to any associated add-on codes. "It's quite common that the NCCI edits do not include all of the add-on codes since the parent codes are included in the edits," explains Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co.

Example 2: None of the edits pertain to 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated). If the physician administers any of the injections listed above while performing 13160, report both codes on the claim.

Pay Special Attention to Modifier Indicators

Two other important edits for pain management specialists involve administering certain injections before performing lumbar discography. CCI 18.3 bundles codes 64483 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance[fluoroscopy or CT]; lumbar or sacral, single level) and 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) into 62290 (Injection procedure for discography, each level; lumbar). The edits carry a modifier indicator of "0," meaning that you cannot append a modifier (such as 59, Distinct procedural service) to bypass the bundling edit and report both codes on the claim.

"There were 474 edit pairs [in CCI 18.3] where the modifier indicator was changed from '1' (you may be able to bypass the policy using a modifier) to '0' (modifiers are not permitted under any circumstance)," says Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla.

CCI 18.3 includes more than 230,000 new non-mutually exclusive edits, according to an analysis by Cohen. For a complete look at the edits, visit the CCI page on the CMS website.