Anesthesia Coding Alert

Bonus: Prepare for neonate hypothermia options in Jan. 2011.

July brings announcements regarding new Category III codes, so prepare now for new transforaminal epidural and hypothermia codes just going into effect or that you'll use beginning Jan. 1, 2011.

Start Using New Transforaminal Choices

The American Medical Association (AMA) released four new transforaminal injection codes in January. They went into effect July 1, so update your systems accordingly:

0228T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level

0229T -- ... each additional level (List separately in addition to code for primary procedure)

0230T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level

0231T -- ... each additional level (List separately in addition to code for primary procedure).

The additions finally give coders specific choices for epidural steroid injections, says Catherine Brink, BS, CPC, CMM, CMSCS, president of Healthcare Resource Management, Inc., in Spring Lake, N.J.

Before filing your first claim with 0228T-0223T, however, pay attention to the associated parenthetical notes regarding techniques and guidance.

Different Technique Changes Codes

The new codes apply when the physician uses ultrasound guidance when administering transforaminal epidural injections. Other codes apply, however, when your provider opts for fluoroscopy or CT guidance. Notes direct you to injection codes 64479-64484 (Injection, anesthetic agent and/or steroid, transforaminal epidural ...) in those situations.

Say 'No' to Radiology

Because 0228T-0231T specify "with ultrasound guidance," you won't need additional codes for the service. Notes state you should not report the new transforaminal epidural codes with:

76942 -- Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation

76998 -- Ultrasonic guidance, intraoperative

76999 -- Unlisted ultrasound procedure (e.g., diagnostic, interventional).

Timing: Watch for 0228T-0231T in the Category III code section of CPT 2011.

Prepare for Neonate Hypothermia Options Two more Category III code additions apply to anesthesiologists, effective Jan. 1, 2011:

0260T --Total body systemic hypothermia, per day, in the neonate 28 days of age or younger

0261T -- Selective head hypothermia, per day, in the neonate 28 days or younger.

Purpose: The new codes help balance out +99135 (Anesthesia complicated by utilization of controlled hypotension [List separately in addition to code for primary anesthesia procedure]) because of the complications associated with newborn care. Reporting 0260T or 0261T give s a clearer picture of the situation than your past option of +99135 with modifier 22 (Increased procedural services). Codes 0260T and 0261T released July 1, 2010, with an implementation date of Jan. 1, 2011. CPT 2012 will add the codes to the Category III section.