Anesthesia Coding Alert

Just because you don’t find 00XXX codes doesn’t mean you should ignore edits.

The latest version of Correct Coding Initiative (CCI) edits went into effect on April 1, with thousands of new edit pairs that stretch across specialties. None actually include codes from CPT^®’s anesthesia section (00100-01999), but they do pertain to common pain management procedures your provider probably offers.

Heads up: There are so many edits in place, it will be easier for you to learn and implement the exceptions rather than the applicable edits themselves.

Remember These IV Infusion Codes

Every pain management code included in CCI 22.1 edits is considered a Column 1 code with each of these IV infusion procedures:

• +96361 – Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)
• +96366 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
• +96367 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)
• +96368 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure).

As the Column 1 code, you should report the anesthesia-related procedure (such as 93503, Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) or the pain management procedure (such as 20552, Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]) if performed during the same encounter as any of the four IV infusion codes above.

Good news: Each edit pair carries a modifier indicator of “1,” meaning that you might be able to report both codes in an edit pair if you have sufficient documentation to support separate coding. If so, you should append a modifier (such as 59, Distinct procedural service) to the Column 2 (IV infusion) code.

“I haven’t seen any of the IV infusion codes billed with anesthesia or acute pain services,” says Kelly D. Dennis, ACS-AN, CANPC, CHCA, CPC, CPC-I,  owner of Perfect Office Solutions in Leesburg, Fla. “Anesthesia providers probably won’t need to be concerned with these edit pairs, but it’s good to know about them.”

Don’t Miss These Edit Exceptions

Although CCI 22.1 bundles the add-on IV infusion codes into virtually every procedure in CPT^®, you’ll still be able to report some services without the work of trying to override an edit. The following procedures can be submitted on the same claim as the IV infusion codes without any special documentation (other than clear notes regarding the services provided):

“Unlisted” codes such as:

  o 64999 – Unlisted procedure, nervous system

Vertebroplasty and kyphoplasty add-on codes:

  o  +22512 – Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)
  o  +22515 – Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure).

Transforaminal epidural add-on codes:

  o  +64480 – Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level (List separately in addition to code for primary procedure)
o +64484 – … lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

Paravertebral facet joint injection add-on codes:

  o +64491 – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)
  o  +64492 – … third and any additional level(s) (List separately in addition to code for primary procedure)
  o +64494 – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure) 
  o +64495 – … third and any additional level(s) (List separately in addition to code for primary procedure)

Destruction procedure add-ons:

  o  +64634 – Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure)
  o +64636 – … lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)
  o +64643 – Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure)
  o +64645 – … each additional extremity, 5 or more muscles (List separately in addition to code for primary procedure)

“It makes sense that ‘unlisted’ codes aren’t included in the edits since they can cover so many different services,” Dennis says. “The primary procedures associated with these add-on codes are bundled with the IV infusion codes, so that would carry over to these codes.”