Anesthesia Coding Alert

HCFAs recent temporary suspension of version 6.3 Correct Coding Initiative (CCI) edits, retroactive to Oct. 30, 2000, will affect anesthesiology coding. The original edits grouped evaluation and management (E/M) services and ophthalmologic E/M codes to more than 800 procedural codes.

This temporary suspension might help anesthesiologists in general, but the prime benefactors will be pain-management practitioners, says Barbara Johnson, CPC, MCP, an anesthesia coding professional with Loma Linda University Anesthesiology Medical Group in Loma Linda, Calif. For example, now you can bill separately some postoperative pain blocks that previously were bundled with the overall anesthesia codes.

Bill as Separate Service With -25 Modifier

According to Barbara Cobuzzi, CPC, CHBME, president of Cash Flow Solutions Inc., in Lakewood, N.J., the original edits were inadequately publicized. The most significant 6.3 edit (bundling E/M services with diagnostic procedures) took many physicians and coders by surprise. They suddenly were receiving denials for previously covered procedures. For example, because electrocardiograms (EKGs) had been bundled to the E/M codes, carriers denied separate claims for EKGs. However, with the suspension, it appears that EKGs filed with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and supporting documentation will be reimbursed as a separate service.

When coding, its important to distinguish that the work of the E/M procedure is significant and separate from the work that is inherent to the primary procedure, HCFA says. This is correct coding that should be practiced regardless of any future edits HCFA might implement. Applications for anesthesia would include pain blocks after surgery or administering a nerve block after general anesthesia for hernia repair.

Reclaim Lost Money With Modifier -25

Suspending the edits also means that providers might recoup some of the reimbursement they lost since the 6.3 edits were implemented. Most of it will come from additional reimbursement for services that can be refiled with modifier -25. Look at the explanation of medical benefits (EOB) on insurance forms to determine which claims that meet separate and significant criteria might qualify for resubmission. The claim could have been denied because the carrier considered it bundled with another code that precluded the same anesthesia provider from billing both codes on the same day. Or perhaps the coder did not use modifiers that explained how and why both service codes should have been paid and/or did not adequately support separate and significant criteria.

Get HCFA Help Before Edits Are Reinstated

Before reinstating any of the suspended edits, HCFA says it will develop a program of carrier guidance and education and provide directions for carriers to publish edit information. The agency will also look at clarifying the criteria for a significant and separate service and consider a national policy that would allow providers to use one diagnosis code for an E/M service/procedure for the same patient on the same day.