Anesthesia Coding Alert

Changes will affect pain management providers more than anesthesiologists.

A new round of CCI (Correct Coding Initiative) edits kicked in July 1, including hundreds of edit pairs that involve procedures anesthesiologists sometimes perform.

The good news for anesthesia coders is that edits are consistent from one procedure code to the next and all involve E/M services. Read on to learn why you don’t need to be intimidated by CCI 19.2.

Consider Your Provider’s E/M Services 

Although each anesthesia-related code has more than 50 new edits associated with it, the edits shouldn’t have a big impact on your day-to-day coding.

Here’s why: The edits all involve E/M services. Anesthesia providers rarely report E/M care because those services are part of the pre-anesthesia work-up and are already compensated through the anesthesia procedure codes (00100-01999).

The new edits clarify that the following anesthesia-related services should be reported instead of any E/M service provided during the same encounter:

• 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]) and 20553 (…single or multiple trigger point[s], 3 or more muscle[s])
• 36555-36571 for insertion of central venous access devices
• 62310-62319 for continuous or single-shot epidural placement
• 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) for Swan-Ganz insertion.

Know the Difference for Pain Management

Pain management specialists might sometimes report E/M codes for office visits. If you code for one of these providers, know that the following E/M services are bundled into the procedures listed above and should not be separately reported under normal circumstances: 

• Patient office visits (99202-99205 for new patients or 99212-99215 for established patients)
• Initial hospital observation care (99218-99220)
• All hospital inpatient E/M services (99221-99239)
• All inpatient and outpatient consultation services (99241-99255)
• Critical care services (99291 and +99292)
• Nursing facility services (99304-99316)
• Most domiciliary and home services (99324-99350)
• Four codes for care plan oversight services (99374, 99375, 99377, and 99378).

Background: E/M services have always been considered part of a procedure by virtue of the rules defining global periods. Minor procedures (those with 0- and 10-day global periods) have included a minor E/M procedure that was not “significant and separately identifiable.” Major procedures (with a 90-day global period) have always included any E/M services provided the day of and the day before the procedure.

“The inclusion of the E/M services have always been by definition of the global period,” says Barbara J. Cobuzzi, MBA, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. “Now it seems that CCI wishes to include these included E/M services by virtue of bundles in addition to the global definitions.”

Double Check for Modifier Possibilities

The vast majority of anesthesia-related edits are due to “CPT^® manual or CMS manual coding instructions,” according to CCI file explanations. 

Nearly all edit pairs carry a modifier indicator of “1,” however, meaning that you might sometimes be able to report both services in an edit pair when they’re completed during the same encounter. If you have clear documentation that justifies reporting both services, include that information with your claim and append a modifier (such as 25, Significant, separately identifiable E/M service) to the E/M code.

Resource: CCI 19.2 added almost 293,000 new edits altogether, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. Read the entire rundown at www.cms.gov.