Anesthesia Coding Alert

Plus: Pay close attention to modifier indicators in CCI 19.0.

The first round of Correct Coding Initiative (CCI) edits for each year is usually the most extensive, and CCI 19.0 effective January 1, 2013, is no exception. We’re here to highlight a few things from the more than 2,050 edits that involve anesthesia codes so you can continue submitting accurate claims for your provider’s services.

Don’t Double Code for Anesthesia With Needle EMG, Other Services

The majority of anesthesia edits fall into the category of "CPT^® manual or CMS manual coding instructions." For example, codes 00210-00222 (Anesthesia for intracranial procedures …) should be reported instead of a wide range of associated procedures, including:

92585 -- Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive

95860 -- Needle electromyography; 1 extremity with or without related paraspinal areas

95910 -- Nerve conduction studies; 7-8 studies

95940 -- Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure).

Many of the same secondary (column 2) codes for edit pairs carry throughout the anesthesia code section of CPT^® 2013. All edits that are justified through CPT^® or CMS instructions carry a modifier indicator of "0," meaning you cannot append a modifier and submit documentation to be paid for both portions of the procedure.

Watch Modifier for ‘Standard Anesthesia Service’ Edits

Other anesthesia edits are in effect because of "Standard preparation/monitoring services for anesthesia." The anesthesia code is listed first in all these edit pairs, meaning it overrides the other code in the pair.

Example: Edits that apply because anesthesia administration is a standard part of the procedure include 01470 (Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified) with 0311T (Non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report), 31647 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve[s], initial lobe), and 99485 (Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; first 30 minutes).

CCI 19.0 lists the same three secondary codes -- 0311T, 31647, and 99485 -- as Column 2 codes for procedures throughout CPT^®’s anesthesia section.

Note: Modifier indicator assignment of "1" or "0" varies for pairs listed in this category. Because of this, you’ll need to pay close attention to whether the modifier indicator is "1," because then you can potentially append a modifier (such as 59, Distinct procedural service) and include documentation to report both service codes.

Don’t Get Excited Over Deleted Edits

CCI 19.0 includes more than 16,000 deleted edits, with virtually every anesthesia code affected by one change. Non-mutually exclusive edits for anesthesia services with 0251T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve[s], initial lobe) have been deleted.

Caution: Don’t start counting the extra money your practice will earn for billing anesthesia services during bronchoscopy. Codes 0250T-0252T have been deleted from CPT^® 2013, which explains the change in edits. New codes 31647-31649 are one-to-one replacements for the previous T codes.

Crosswalk tip: Codes 31647 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve[s], initial lobe) and 31648 (… with removal of bronchial valve[s], intial lobe) each cross to anesthesia code 00520 (Anesthesia for closed chest procedures; [including bronchoscopy] not otherwise specified), says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. If the patient is under 1 year of age, report alternate code 00326 (Anesthesia for all procedures on the larynx and trachea in children younger than 1 year of age).