Anesthesia Coding Alert

Be sure you know how to handle the situation

The latest round of National Correct Coding Initiative (CCI) edits went into effect July 1, 2018, with many new additions including some common codes for pain management injections.

Watch for Edits Involving C9738 and C9748

All anesthesia and pain management edits in version 24.2 include one of two new HCPCS codes for 2018:

• C9738 – Adjunctive blue light cystoscopy with fluorescent imaging agent (list separately in addition to code for primary procedure)
• C9748 – Transurethral destruction of prostate tissue; by radiofrequency water vapor (steam) thermal therapy.

The number of edits pairing these codes with anesthesia or pain management services is rather daunting at first glance. For example, you cannot report 00910 (Anesthesia for transurethral procedures [including urethrocystoscopy]; not otherwise specified) or 00916 (… post-transurethral resection bleeding) with C9738.

Injection procedures that you’re no longer allowed to report with C9738 or C9748 is extensive – and includes many of your most popular injection procedures. Some examples include:

• 64461 - 64463 – Paravertebral block (PVB) (paraspinous block), thoracic …
• 64479 and +64480 – Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT) …
• 64483 and +64484 – Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT) …
• 64486 - 64489 – Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) …
• 64490 - +64495 – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT) …
• 64505 - 64530 – Injection, anesthetic agent … to anatomic sites including the carotid sinus, stellate ganglion, superior hypogastric plexus, paravertebral sympathetic nerve, and others

The edits with C9748 even branch into some Category III/temporary codes:

• 0216T – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level 
• 0228T – Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level
• 0230T – Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level.

All of these edits list C9738 or C9748 as the Column 1, or comprehensive, procedure in the pair, meaning that code should be reported instead of the anesthesia or injection code. CCI has assigned modifier indicator “0” to each edit pair, so coders will be unable to include a modifier to “break” the edit and report both procedures when performed during a single encounter.

Now, Watch for the Silver Lining

Once you see the edits, however, don’t lose all hope of getting reimbursed for your provider’s anesthesia or pain management work in these situations. Remember that CCI edits only apply when a single provider performs the services represented by both codes during the same session.

Translation: A urologist cannot perform both services in any of the edit pairs and be reimbursed; he or she can only report either C9738 or C9748. If, for some reason, both procedures are needed and the urologist (or other physician) requests that the anesthesiologist or pain management specialist to administer the block or injection, each physician will file a claim for only the service that was personally rendered. In that scenario the urologist would report either C9738 or C9748 and your physician would report the appropriate injection/block code.

Why it matters: CMS plans to track the utilization and costs associated with white light/blue light cystoscopy procedure combinations that will receive a complexity adjustment, according to a blog post written by Renee Dustman, BS, AAPC MACRA Proficient, an executive editor at AAPC.

NCCI version 24.2 included 2,880 new code pairs and 6 deleted pairs.