Anesthesia Coding Alert

New edits reach across the anesthesia spectrum.

Anesthesia providers are being hard-hit with CCI edits in the first quarter of 2016, with more than 2,700 new edit pairs going into effect for the specialty on Jan. 1.

Simple strategy: Adjusting to the edits won’t be difficult since they pertain to virtually every anesthesia code. Once you get familiar with the Column 2 codes, know you shouldn’t be reporting them with most anesthesia services (though double check before automatically skipping them since they might be allowed in a few situations).

Each code listed in these edits as a Column 2 component of anesthesia services is new for 2016. They are:

• 31652 – Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures
• 31653 – … with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures
• 92537 – Caloric vestibular test with recording, bilateral; bithermal (i.e., one warm and one cool irrigation in each ear for a total of four irrigations)
• 92538 – … monothermal (i.e., one irrigation in each ear for a total of two irrigations)
• 93050 – Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform(s), digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity artery, non-invasive
• 99415 – Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
• 99416 – … each additional 30 minutes (List separately in addition to code for prolonged service)
• 99497 – Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.

Two additional codes are included in edits with some anesthesia services:

• 64461 – Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)
• 64463 – … continuous infusion by catheter (includes imaging guidance, when performed).

The rationale for all edits is “Standard preparation/monitoring services for anesthesia.” However, the designation with either modifier “0” or “1” is about 50/50.

Remember: A modifier indicator of “0” indicates that an edit can never be bypassed even if a modifier is used. In other words, the Column 2 code of the edit will be denied. A modifier indicator of “1” indicates that an edit may be bypassed with an appropriate modifier appended to the Column 2 code. If the pair that applies to your situation has a “1” modifier indicator, you might be able to report – and be paid for – both procedures with sufficient documentation.

Example: Each edit pair with 31652 or 31653 carries modifier 1, so separate reporting might be allowed. Each edit pair with 99145 or 99146 for prolonged clinical staff services carries modifier 0 so you should report only the anesthesia code.

Good news: The edits still do not bundle invasive monitoring lines (such as CVP, arterial, or Swan-Ganz lines) with the newly announced pairs, points out Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. This is good news for anesthesiologists because you can continue to report those line placement services separately.

Deletions: CCI updates will occasionally include deletions that reverse previous edits and allow you to submit code pairs that had been banned. The January CCI file does list thousands of deleted edits, but don’t get your hopes up for new reimbursement. Each pair includes a code that is no longer valid as of Jan. 1, 2016, such as 64412 (Injection, anesthetic agent; spinal accessory nerve).