Anesthesia Coding Alert

 Q3 changes expand percutaneous vertebroplasty, disc decompression options  

 The Correct Coding Initiative (CCI), version 13.2, has good news for anesthesia and pain management coders: You can report some services together that previous edits prohibited.
 The changes apply to some column 1/column 2 edits. This group of edits (formerly known as comprehensive/component edits) represents services that you should not typically report together because the column 1 wider-scope procedure includes the services represented by the column 2 code. But CCI edits effective July 1 delete some of these edits, which means you can now code the services separately during the same session, says Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif.

Epidural During Percutaneous Vertebroplasty or Kyphoplasty Is OK 

 Several edit deletions apply to pain management procedures during percutaneous vertebroplasty. If your physician determines that the patient has multiple conditions and requires both an epidural or paravertebral facet joint injection along with a percutaneous vertebroplasty procedure for a thoracic or lumbar compression fracture, chances are you can code both services ��" without worrying about appending a modifier to indicate a different anatomic site.

 The affected percutaneous vertebroplasty/kyphoplasty codes include:
• 22520 -- Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic
• 22521 -- ... lumbar
• 22523 -- Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty); thoracic
• 22524 -- ... lumbar.

 Missing code: When you study this set of edits, you find that the change doesn't include add-on code +22522 (... each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]). CCI edits typically don't include add-on codes because you can't bill them without the primary codes, Johnson says. The edits associated with the primary codes are adequate to prevent inappropriate payment for the add-on code. Hence, the add-on codes are not usually included in the CCI files.

 Procedures you can now report with percutaneous vertebroplasty and kyphoplasty include:
• 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
• 62319 -- ... lumbar, sacral (caudal)
• 64470 -- Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level
• 64475 - ... lumbar or sacral, single level.

 Edit effects: These edits might not affect your day-to-day coding because physicians don't normally perform these services during the same session. In case your physician does, however, now you won't have to remember to append modifier 59 (Distinct procedural service) to bypass the edits and get reimbursement.

Follow Changes With Ease

 Clip and save the chart (above) for an easy way to follow which anesthetic services edits CCI now allows with percutaneous vertebroplasty procedures.

Check Decompression Procedures, Too

 The other edit deletions of interest to pain management providers deal with disc decompression.
You can now submit 62318 or 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) with 62287 (Aspiration or decompression procedure, percutaneous, of nucleus pulpopus of intervertebral disc, any method, single or multiple levels, lumbar [e.g., manual or automated percutaneous discectomy, percutaneous laser discectomy]).  

 Rationale: Some coders are glad to see this edit deletion, simply because the previous pairing -- a cervical/thoracic procedure with a lumbar procedure -- didn't seem to make much sense anatomically. Now there won't be confusion over whether you can report both services during the same session.

 Share input: If you have questions or concerns about certain CCI code pairs, send your inquiries to National Correct Coding Initiative; Correct Coding Solutions LLC; PO Box 907; Carmel, IN 46082-0907. Send your question to the attention of Niles R. Rosen, MD, medical director, and Linda S. Dietz, RHIA, CCS, CCS-P, coding specialist. You can also fax comments to (317) 571-1745.