Anesthesia Coding Alert

Hint: Most apply to epidural choices.

January brought a new version of Correct Coding Initiative (CCI) edits, with thousands of changes going into effect. Hundreds of these will affect your anesthesia coding, thanks to the new epidural codes and some others you might use on a regular basis.

Start by Ignoring Anesthesia With Epidurals

CCI edits bundle virtually every anesthesia CPT^® code into a group of thirteen procedures. Eight of these represent the newly established codes for epidural administration:

• 62320 – Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
• 62321 – ... with imaging guidance (i.e., fluoroscopy or CT)
• 62322 – Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
• 62323 – ... with imaging guidance (i.e., fluoroscopy or CT)
• 62324 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
• 62325 – ... with imaging guidance (i.e., fluoroscopy or CT)
• 62326 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
• 62327 – ... with imaging guidance (i.e., fluoroscopy or CT).

"Seeing the anesthesia codes bundled with epidurals really isn't a surprise since that's how it was with the previous epidural codes," says Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. "It's just another thing coders will need to remember as they adjust to reporting epidurals with the new codes."

There's hope: Edit pairs involving anesthesia services with epidural codes 62320-62327 as well as with 76970 (Ultrasound study follow-up [specify]) have a modifier indicator of "1." That means you might sometimes be able to "break" the bundle and report both codes – in special circumstances and with sufficient supporting documentation.

Watch Any Claims With Moderate Sedation

Anesthesia codes are also bundled into moderate sedation services. You might rarely report moderate sedation as an anesthesia coder, but it's still a good idea to keep up with the changes.

And, as with epidural injections, remember CPT^® 2017 adds new moderate sedation codes to the mix.

The new codes are based on three factors: whether or not an independent trained observer is needed during the procedure, the patient's age, and the length of intraservice time. Your six choices 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)
• 99155 – Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age
• 99156 – ... initial 15 minutes of intraservice time, patient age 5 years or older
• 99157 – ... each additional 15 minutes intraservice time (List separately in addition to code for primary service).

The coding edits involving anesthesia procedures and the new moderate sedation codes each have a modifier indicator of "0," meaning you cannot break the pair and report both services, even with what you might think is sufficient documentation.

Verify Before Reporting Epidurals With Other Procedures

Each of the new epidural codes also is the Column 1 code in edits with more than 200 other procedures. The paired procedures cover too many services to list in their entirety, but this will give you a sample of the range:

• 0178T – Electrocardiogram, 64 leads or greater, with graphic presentation and analysis; with interpretation and report
• 12015 – Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm
• 20605 – Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance
• 36400 – Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein
• 64479 – Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level
• 77001 – Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)
• 93000 – Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
• 95907 – Nerve conduction studies; 1-2 studies
• J2001 – Injection, lidocaine HCl for intravenous infusion, 10 mg.

Most of the edits have a modifier indicator of "1," so pay attention to that before filing the claim.

Don't Expect Help From Deletions

Sometimes deleted edits can help your bottom line because the edit reversal means you can get paid for both services instead of only one. That isn't the case with these first edits of 2017, however; all "deleted edit" pairs include a code that was deleted for 2017.

For example, some of the deleted edits include codes 0282T (Percutaneous or open implantation of neurostimulator electrode array[s], subcutaneous [peripheral subcutaneous field stimulation], including imaging guidance, when performed, cervical, thoracic or lumbar; for trial, including removal at the conclusion of trial period), 62310 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic), and 99143 (Moderate sedation services [other than those services described by codes 00100-01999] 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; younger than 5 years of age, first 30 minutes intra-service time).

Don't Pull the Trigger on TPI Injections

If you sometimes code for pain management services, reporting trigger point injections with 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]) and 20553 (... single or multiple trigger point[s], 3 or more muscle[s]) is nothing new. Both TPI codes, however, are Column 1 components of edits with more than 30 other services.

You'll want to look through the list yourself, but a few of the procedures paired with 20552 and 20553 are:

• 0216T – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level
• 64400 – Injection, anesthetic agent; trigeminal nerve, any division or branch
• 64510 – Injection, anesthetic agent; stellate ganglion (cervical sympathetic)
• 99155 – Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age.

Bottom line: The first round of edits for a new year traditionally are the most extensive, and these are no exception. Be sure to check the full lists at CMS.gov before filing claims.