Anesthesia Coding Alert

CCI 18.3 also classifies epidural patches above repairs.

The most recent edition of Correct Coding Initiative (CCI) edits go into effect Oct. 1, with changes applying to how you report A-line or central venous catheter insertion and epidural blood patch injections.

Choose A-Line, Cath Insertion Over Wound Repair

Nearly 50 edits from CCI 18.3 focus on arterial line placement and wound repair. If the anesthesiologist is present and places an A-line during the procedure, report 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) instead of a code for simple, intermediate, or complex repair.

The edit applies to the following codes:

• 12001-12021 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet] ...)
• 12031-12057 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet] ...)
• 13100-+13153 (Repair, complex ...).

Four codes for insertion of a tunneled or non-tunneled central venous catheter also override the codes for simple, intermediate, or complex wound repair (as listed with the A-line insertion edits above). The codes you should submit during these situations are:

• 36555 (Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age)
• 36556 (... age 5 years or older)
• 36557 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age)
• 36558 (... age 5 years or older).

"We're typically reporting anesthesia (ASA) codes instead of surgical codes, so this edit might not have much effect on anesthesiologists," says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. "But I've learned to never say never, so it's good to be aware of the change."

Report Epi Blood Patch Before Wound Repair

The same type of edit also applies to epidural blood patches administered during the same session as wound repair. Code 62273 (Injection, epidural, of blood or clot patch) overrides any of the simple, intermediate, or complex repair codes.

You normally report 62273 when the anesthesiologist uses an epidural blood patch to treat a spinal headache after the patient's labor and delivery. A situation involving 62273 in conjunction with wound repair might be rare, but you'll know to submit the patch code.

Watch for Chances to Submit Both Procedures

Each edit listed above is considered a comprehensive/component edit, meaning the services shouldn't be billed together because one service inherently includes the other (also known as bundled services). When you have adequate documentation and submit both codes for the same patient during the same encounter, Medicare (and many other payers) ordinarily will pay only for the higher-valued procedure.

Exception: The line placement and epi patch edits in CCI 18.3 all carry a modifier indicator of "1," meaning you can sometimes append a modifier and report both codes from the edit pair. You would append a modifier (usually 59, Distinct procedural service) to the lower-value code before submitting the claim.

Edits overview: CCI 18.3 adds more than 233,000 new edit pairs to the database, according to an analysis by Frank Cohen of the Frank Cohen Group, a consulting firm specializing in analytics based in Clearwater, Fla. More than 97 percent of the new edits apply to surgical procedures (codes 10000-69999), and almost all fall within the policy statement, "Misuse of Column 2 code with Column 1 code."