Anesthesia Coding Alert

Latest coding edits pair thousands of procedures with common anesthesia procedures.

The latest Correct Coding Initiative (CCI) edits went into effect on Jan. 1, 2014, with anesthesia codes and other common procedures your anesthesiologist performs affected by thousands of new edit pairs. Simply remembering a few key procedures that are included in the anesthesia service, however, will help you make the transition with ease.

Note: All anesthesia procedural edits in CCI 20.0 are classified as non-mutually exclusive, meaning you should not report both services in an edit pair on the same claim for work during the same patient encounter. They’re also known as comprehensive/component edits because one service inherently includes the other. In each case, you’ll report the anesthesia or anesthesia-related code instead of the other service.

Submit Anesthesia Code Over Consultative Services

Thousands of edits apply to time the physician might spend on telephone or internet assessments and consultations:

• 99446 – Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review
  
• 99447 – … 11-20 minutes of medical consultative discussion and review
  
• 99448 – … 21-30 minutes of medical consultative discussion and review
  
• 99449 – … 31 minutes or more of medical consultative discussion and review.
  

These codes are new for 2014 and are intended to be used when your physician provides a consult by telephone or internet to another requesting provider. CCI specifies that the consults are inherent to many common services including every anesthesia code from CPT® and other frequent procedures such as A-line placements 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) and 36625 (… cutdown) and Swan-Ganz insertion 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes).

Note: Each edit carries a modifier indicator of “0,” so you cannot append a modifier to break the edit and report both services. Only file for the face-to-face service provided, not the phone consultation.

Verify Whether Transitional Care Is Reportable

You began reporting transitional care management (TCM) codes in 2013, but had to work your way around numerous coding edits introduced throughout the year. The same holds true for TCM codes this year:

• 99495 – Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; Medical decision making of at least moderate complexity during the service period; Face-to-face visit, within 14 calendar days
  
• of discharge
  
• 99496 – … within 7 calendar days of discharge.
  

These codes are bundled into all anesthesia services and many other procedures just as the consultative services codes listed above.

Pay attention: Some edit pairs involving 99495 and 99496 are associated with modifier indicator “0,” but others with modifier indicator “1.” When the modifier indicator is “1” you might be able to report both services from the same patient encounter together. If so, you would append a modifier such as 59 (Distinct procedural service) to the bundled code.

Example: Edits pair 99495 and 99496 with epidural codes such as 62310 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic). Because the edit pair is listed with modifier indicator “1,” you could possibly report the epidural along with transitional care management.

Resource: Check the complete CCI file on the CMS website to see which edits will apply to your practice. Log onto www.cms.gov and search for “CCI 20.0”. Edits under CCI 20.0 are effective from Jan. 1, 2014 until March 31, 2014.