Anesthesia Coding Alert

The newest round of Correct Coding Initiative (CCI) edits (8.3) released in October means many changes for anesthesiologists dealing with pain management procedures. Few anesthesia providers will be affected by the mutually exclusive edits, but changes to the comprehensive and component codes are another story.

More than 54,000 edits were made to comprehensive and component codes. "Many common procedures for pain management are included in the new comprehensive edits," says Linda Runfola, CPC, an anesthesia and pain management consultant with NAPA Management Services in Syracuse, N.Y., "so it's important to review them carefully. As you find additions to your most common procedures, either highlight them or note them in some way so you can remember the changes."

Component codes are included in services designated by broader-scope comprehensive codes. This means that if you perform the whole (or comprehensive) service, you cannot bill the individual parts (or components). If you don't do the entire comprehensive procedure, you bill the components that were performed.

"The physicians should document everything they do," says Barbara Johnson, CPC, MPC, professional coder with Loma Linda University Medical Group Inc. in Loma Linda, Calif. "The coder will then figure out the highest reimbursement code, what is included in that service, and whether any services are bundled."

Most of the changes to CCI 8.3 include too many comprehensive codes to print complete lists here, but this will give you an overview of what to expect. Get your complete copy of CCI edits from the National Technical Information Service (NTIS, the authorized distributor for CMS) by calling (800) 363-2068. You can also call this number to subscribe to the quarterly updates.

Tendon and Trigger Point Injection Codes Now Bundled

Anesthesia providers have made great use of the trigger point injection and associated codes introduced in CPT 2002. This group includes:
 

CCI 8.3 lists each of these injection codes as components of many procedures. For example, they have now been bundled with many common nerve injections including 64400* (Injection, anesthetic agent; trigeminal nerve, any division or branch); nerve procedures such as 64834 (Suture of one nerve, hand or foot; common sensory nerve); and radiology procedures such as 72240 (Myelography, cervical, radiological supervision and interpretation), 72295 (Diskography, lumbar, radiological supervision and interpretation) and 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]).

Changes to Epidural and Somatic Nerve Injection Codes

Epidural injections are so common that coding for them should be a no-brainer for most professionals. But now two of the most frequently used epidural codes (62318, Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic; and 62319, lumbar, sacral [caudal]) are each bundled with thousands of comprehensive codes. This is because there are many procedures when an approach to the epidural space is only part of the procedure (see the following information regarding percutaneous vertebroplasty), so the epidural becomes a component of a more comprehensive code.

Twenty-five codes in CPT deal with somatic nerve injections obviously a very common procedure. Five of the most commonly used codes from this group are now considered to be components of thousands of comprehensive codes:

"As pain management grows as a specialty and the epidural becomes a common way to relieve pain, including the epidural code in procedures will become the routine," Johnson predicts. "If a procedure is routinely part of other procedures, Medicare and CMS include it in the CCI edits. Seeing the epidural codes bundled with other procedures shows that they've become a routine part of many procedures."

Check the complete CCI 8.3 edits to see which comprehensive codes the epidurals and somatic nerve injections are now bundled with.

Percutaneous Vertebroplasty and Fluoroscopy Changes

Of these thousands of edits, two codes related to percutaneous vertebroplasty are of particular interest to anesthesia providers: code 22520 (Percutaneous vertebro-plasty, one vertebral body, unilateral or bilateral injection; thoracic) and code 22521 ( lumbar). Epidural codes 62318 and 62319 and the five somatic nerve injection codes outlined above are now components of these percutaneous vertebroplasty procedures.

It's important to note that the third percutaneous vertebroplasty code, +22522 ( each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]), was not included in the edits. Johnson explains that this is because 22522 is an "each additional" code and will always be reported with either 22520 or 22521. As such, it doesn't need to be included in any bundling.

Although fluoroscopy is not an anesthesia service, it's an area that anesthesia providers who use this technique should be well aware of. The primary procedure code for fluoroscopy (76000, Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) is now included with a range of comprehensive codes.

Adjust to Edits Gradually

Coders and practitioners are inundated with new CCI edits each quarter, and many feel pressured to read and absorb everything. But since this is virtually impossible, Johnson advises you to start by reviewing edits that affect your most common procedures. Then incorporate other edits into your coding as they apply, and avoid being quite so daunted by all the changes at once.