Anesthesia Coding Alert

Hold off on applicable claims until April 1, to simplify reimbursement.

As reported in the last issue of Anesthesia Coding Alert (Vol. 19, N. 2), the newest edition of National Correct Coding Initiative (NCCI) edits bundled anesthesia procedures into six codes for moderate sedation services. Those changes were effective Jan. 1, 2017, but CMS issued a correction related to moderate sedation edits on Jan. 23, 2017. 

According to CMS, the NCCI contractor notified the organization of an error in the edit table regarding reporting moderate sedation with CPT^® codes 99151-99153. The edit table incorrectly bundled the codes into seventeen global surgical procedures and sixteen Category III codes. NCCI showed these edits with a modifier indicator of "0," indicating that you could not bypass the edit with approved modifiers and documentation when appropriate. 

"Anesthesia coders don't normally report moderate sedation services, so the changes won't necessarily apply to them," says Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. "But it's always good to know about edits that affect areas similar to your specialty. Plus, if you report pain management services, you might report these codes periodically."

The correction: Moderate sedation can be separately reported with the services represented by these particular surgical and Category III codes. The codes impacted by the correction are: 

• 0424T – 0436T – Codes for insertion, replacement, removal, or repositioning of a neurostimulator system to treat central sleep apnea
• 0459T – 0461T – Codes representing services with an implanted aortic counterpulsation ventricular assist device (such as repositioning)
• 36901 – 36903 – Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documen­tation and report ...  
• 36904-36906 – Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intrapro­cedural pharmacological thrombolytic injection(s) ...
• +36907 – Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure) 
• +36908 – Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure) 
• +36909 – Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure)
• 37246 – 37249 – Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery ...
• 43210 – Esophagogastroduodenoscopy, flexible, transoral; with esopha­gogastric fundoplasty, partial or complete, includes duodenoscopy when performed
• 45399 – Unlisted procedure, colon
• 45990 – Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic
• 61640 – Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel.

The moderate sedation codes you can report with these services are: 

• 99151 – Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age 
• 99152 – ... initial 15 minutes of intraservice time, patient age 5 years or older
• 99153 – ... each additional 15 minutes intraservice time (List separately in addition to code for primary service).

The bundling/modifier indicator errors will be corrected in the NCCI update to be published April 1, 2017.

Hold your claims: Since the corrections won't be effective until April 1, any claims submitted prior to that date will be denied. Any denials can be appealed on or after April 1, 2017. NCCI recommends that you avoid denials and streamline reimbursement by not submitting any claims for moderate sedation codes 99151-99153 with the surgical and Category III codes in question until after the correction is official.