Anesthesia Coding Alert

These procedures rarely require anesthesia other than conscious sedation (99141, Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation), so the edits won't affect coding for most cases. On the other hand, it does mean that you can no longer bill anesthesia separately when you use it for procedures involving children or mentally ill patients or for other unusual circumstances.

In other endoscopy-related edits, CCI now considers 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum) a component of new codes 43201 (Esophagoscopy, rigid or flexible; with directed submucosal injections[s], any substance) and 43236 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed submucosal injection[s], any substance).

Pain management practitioners should heed new edits that bundle nerve blocks and single or epidural injections with various procedures.

CCI now considers new codes 01991 (Anesthesia for diagnostic or therapeutic nerve blocks and injections [when block or injection is performed by a different provider]; other than the prone position) and 01992 ( prone position) as components of trigger point injection codes 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) and 20553 ( single or multiple trigger point[s], three or more muscles). Because physicians rarely require anesthesia to perform a trigger point injection, this is another set of edits that probably won't come into play very often.

The previous round of edits bundled several new somatic nerve injection codes with anesthesia codes. NCCI 9.1 bundles somatic nerve injections and single or epidural injection codes with several standard physical therapy-related services. The component injection codes are:

The edits bundle all of these codes with a variety of physical medicine and osteopathic services, including physical therapy evaluation (97001), specific therapeutic procedures (97110-97139), orthotics fitting and training (97504), prosthetic training (97520), osteopathic manipulative treatment (98925-98929), and similar services.

"These particular edits prevent anesthesiologists from administering a block and billing for physical therapy at the same time," says Barbara Johnson, CPC, MPC, with Loma Linda University Anesthesiology Medical Group in Loma Linda, Calif. "There may have been problems with physicians performing a block and then exercising the patient when he was pain-free, then billing for both services."

The tables turn with the next set of anesthesia-related edits for somatic (64400-64484) and sympathetic nerve injections (64505-64530). CCI lists these injections as the comprehensive service for a variety of codes including 90784 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; intravenous), 93000-93010 (services related to Electrocardiogram, routine ECG with at least 12 leads) and 93040-93042 (services related to Rhythm ECG, one to three leads).