Anesthesia Coding Alert

Version 9.0 of the Correct Coding Initiative (CCI) edits, effective from Jan. 1 to March 31, has fewer total changes than other editions in 2002, but more edits directly affect anesthesia and pain management providers than in recent versions.

The new CCI Edits includes more than 19,000 comprehensive and component code edits. Most notable is the bundling of virtually all anesthesia codes with E/M services or other procedures. There are too many edits to mention individually here, but this will provide you with an overview of changes. Get your copy of CCI edits from the National Technical Information Service (NTIS) by calling (800) 363-2068. You can also call this number to subscribe to the quarterly updates. Start by Knowing Your Terminology To know how the edits affect your practice, you must first understand the terminology CCI uses. Some edits are mutually exclusive, which means that the codes listed in edits represent procedures that cannot reasonably be performed during the same care session. Kelly Dennis, CPC, EFPM, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla., offers these examples of mutually exclusive edits:

Codes CPT 33216 (Insertion of a transvenous electrode; single chamber [one electrode] permanent pacemaker or single chamber pacing cardioverter-defibrillator) and 33207 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; ventricular) are mutually exclusive. They would never be billed together, and because 33216 pays less, Dennis says, the carrier will automatically apply the lower-paying code and reject the higher-paying one if you are billing as the surgeon. Both codes cross to anesthesia code 00530 (Anesthesia for permanent transvenous pacemaker insertion). From a pain management perspective, 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver) and 63685 (Incision and subcutaneous placement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling) are mutually exclusive. Again, the lower-paying code is the one that carriers will reimburse if you report the codes together. Dennis says Florida reimbursed practitioners $434.55 for code 63685 in 2002 and $348.65 for code 63688. Nonmutually exclusive edits apply to services that might be performed during the same session but that aren't billable together. This is because one of the codes known as the component code is included in the services represented by the second, broader-scope comprehensive code. If the physician performs the whole or comprehensive service, you bill the comprehensive code instead of the individual parts or components. You can bill individual components if the physician doesn't perform the entire comprehensive procedure. New Codes Are Bundled with More Than 80 Procedures CPT 2003 introduced 10 new anesthesia codes. Most of them include a note stating you should not report them with +99100 (Anesthesia for patient of extreme [...]