Anesthesia Coding Alert

Tip: Pay special attention if you sometimes report pain management services.

Fall is here, and with it comes the first look at CPT^® code changes for CY 2020. And while the first look at updates doesn’t include any changes to the anesthesia section, several will come into play when you’re reporting pain management services.

“Coders must understand the importance of reviewing the revised CPT^® codes the AMA publishes each year — since the result of using a code description that has been revised could be that the claim does not get paid,” says Ronda Tews, CPC, CHC, CCS-P, AAPC Fellow, director of billing and coding compliance at Modernizing Medicine in Boca Raton, Florida. “However, without a review of the code description changes for your specialty each year, the implications could be significantly worse — the claim could get paid when it shouldn’t.”

Check Out the New Injection and Destruction Codes

CPT^® 2020 is set to include two new codes for anesthetic agent injections and two for nerve destruction. The injection codes are:

• 64451 (Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography))
• 64454 (Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed).

Pain management coders have not had detailed code options for these procedures in the past, though the HCPCS manual does include G0260 (Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography). Adding 64451 and 64454 to your coding toolbox means you can report appropriate CPT^® procedure codes instead of resorting to HCPCS or 64999 (Unlisted procedure, nervous system).

Tip: “Look at the private payers and states that have local coverage determinations (LCDs) for Medicare, to see if they add any further requirements with the new SI nerve block and ablation codes,” says David Waldman, COC, CPC, with Headache and Pain Center, PA in Overland Park, Kan. “My belief is the current coverage policies describe SI injections into the joint so the policies will have to expand for SI joint procedures that involve the innervating nerves and ablation of those nerves.”

The two new nerve destruction choices are:

• 64624 (Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed)
• 64625 (Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)).

As with the injections represented by new codes 64451 and 64454, you’ve had to report 64999 for the destruction and RFA procedures associated with new codes 64624 and 64625. As every coder knows, anytime you can submit a specific code rather than an “unlisted” option, your chances of appropriate reimbursement improve.

Don’t Miss These Injection Revisions

Several oft-used anesthetic injection codes will be revised in 2020. Each descriptor expands to read “anesthetic agent(s) and/or steroid.” There are too many affected codes to list here, but a few examples are:

• 64400 (Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular))
• 64405 (Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve)
• 64417 (Injection(s), anesthetic agent(s) and/or steroid; axillary nerve)
• 64420 (Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level)
• 64449 (Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement))
• 64450 (Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch).

Some of the revisions affect codes for either single injections or continuous infusion to the nerve. For example:

• 64415 (Injection(s), anesthetic agent(s) and/or steroid; brachial plexus)
• 64416 (Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous infusion by catheter (including catheter placement))
• 64445 (Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve)
• 64446 (Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement)).

But there’s more: The “steroid” addition to the descriptor isn’t the only change for some of these procedure codes. For example, the current descriptor for 64400 is “Injection, anesthetic agent; trigeminal nerve, any division or branch.” The revised descriptor for 2020 specifies the applicable nerve branches rather than using the general term “any.”

As another example, the current descriptor for code 64421 is “Injection, anesthetic agent; intercostal nerves, multiple, regional block.” Beginning in January 2020, it will be considered an add-on code that can only be reported in conjunction with a primary procedure code. 

Select ‘Unlisted’ Instead of These Newly Deleted Codes

The last change you’ll need to address is deleted codes. You’ll no longer find these three injection codes in CPT^® 2020:

• 64402 (Injection, anesthetic agent; facial nerve)
• 64410 (Injection, anesthetic agent; phrenic nerve)
• 64413 (Injection, anesthetic agent; cervical plexus).

With these codes deleted, you’ll report injections to these nerves with 64999 and include supporting documentation to explain the provider’s work.