Anesthesia Coding Alert

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.

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 age, under 1 year and over 70 [list separately in addition to code for primary anesthesia procedure]) or 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation). CCI 9.0 expands use restrictions by bundling all the new anesthesia codes with more than 80 procedure codes. These bundlings are nonmutually exclusive edits, with the anesthesia code representing the comprehensive service.

The bundling begins within the anesthesia section itself CCI considers 01995 (Regional intravenous administration of local anesthetic agent or other medication [upper or lower extremity]) and 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) to be components of all new anesthesia codes.

This bundling is a big change, Dennis says. Until now, you could use 01996 for follow-up days when the anesthesiologist placed a catheter exclusively for postoperative pain and not for anesthesia. "If it was placed and used for the mode of anesthesia, you would also use 01996 for follow-up days and not bill the catheter insertion," she explains. "Now you'll use 01996 for follow-up days if the catheter is placed and used for anesthesia during surgery. If it's not used for the anesthesia, E/M codes must be reported instead."

New text beneath 01996's descriptor in CPT 2003 states that it is for management of an epidural or subarachnoid catheter "placed primarily for anesthesia administration during an operative session, but retained for postoperative pain management." Under these circumstances, codes 62318 and 62319 for continuous epidurals are part of the anesthesia and are not billed separately unless the epidural or subarachnoid catheter is placed primarily for pain instead of surgical anesthesia.

Other procedures that CCI bundles as components of the new anesthesia codes include:

But the edits don't stop there. Version 9.0 pairs a group of 16 codes as components of all other anesthesia codes. These include some codes for somatic injections, most codes related to routine EEGs (electroencephalography), and some E/M services.

Pain management coders were happy to see the addition of several new somatic nerve injection codes in CPT 2003. These are all now classified as components of anesthesia codes.

The affected injection codes are:

Administering anesthesia while performing these injections is not very common, but there are occasions when it might be necessary, says Barbara Johnson, CPC, MPC, of Loma Linda University Anesthesiology Medical Group in Loma Linda, Calif. Two physicians would be present in this situation (one to administer anesthesia and the other to perform the injection). Modifier -23 (Unusual anesthesia) might be necessary for the claim, as well as supporting documentation to prove anesthesia's necessity.

You should note that the anesthesiologist must document medical necessity when he or she administers anesthesia with any injection code, Dennis says. Report the injection codes as usual when they are stand-alone codes for pain management services and are not used for any type of anesthesia delivery.

Until now, some coders reported the injection location (such as 00630 [Anesthesia for procedures in lumbar region; not otherwise specified] for a lumbar block) when the anesthesiologist provided monitored anesthesia care (MAC) for pain injections or blocks, Dennis points out. "This was a high base for a low-level procedure. I guess they found a reasonable way to lower the anesthesia reimbursement when blocks are given."

CCI 9.0 includes many services in the global anesthesia fee that other physicians code as E/M visits. There are times when anesthesiologists can bill for E/M services in addition to anesthesia care, but those times will be even more rare thanks to bundles in CCI 9.0. The new version now considers four E/M codes related to pediatric services components of virtually all anesthesia codes. The affected E/M codes include:

Three of these four codes (99293, 99294 and 99299) are new in CPT 2003, but Johnson doesn't expect the edits to affect anesthesia providers very much. "These are neonatal intensive care codes, and an anesthesiologist generally will not be a neonatal intensivist," she says.