Anesthesia Coding Alert

Coding Update:

Will You Be Ready to Begin Using CPT 2005 on Jan. 1? Gauge New Codes' Effects Today

Published on Mon Nov 22, 2004

Plus: 5 new codes you won't find in the anesthesia section but need to know

When Jan. 1 rolls around, no office or facility can afford to be caught resting on its CPT 2004 laurels. We've got the scoop on the new anesthesia - and nonanesthesia - codes that you need to master before the new year.

Add This Code to Your Anesthesia Section Lineup

CPT 2005 brings only one major change to the anesthesia section of your CPT manual, the addition of code 00561 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, under one year of age).

"This code was necessary because the work involved in providing anesthesia for an infant is different from treating an older patient," says Scott Groudine, MD, an Albany, N.Y., anesthesiologist.

Code 00561 is expected to reflect that additional work by having a unit value of 25. (That puts it on the same level of involvement as 00563 for hypothermic circulatory arrest; codes 00560 and 00562 have 15 and 20 base units, respectively.) Code 00561 expands your options for anesthesia during heart procedures. Others in this group include:

00560 - Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator

00562 - ... with pump oxygenator

00563 - ... with pump oxygenator with hypothermic circulatory arrest.

Heads-up: Pediatric hospitals and teaching facilities, take note - 00561 will have the greatest effect on you because it is specifically for coding pediatric open-heart surgeries.

Don't Overlook Codes Outside Your Section

Anesthesia coders' lives would be a lot easier if they just coded from CPT's anesthesia section - but you don't. You rely on codes throughout the book for various services, which means it's good to know about changes in other sections that might affect you.

One new code of possible interest is 32019 (Insertion of indwelling tunneled pleural catheter with cuff). This could be used for pain management following thoractomy or to treat pain in terminal cancer patients or patients with multiple fractured ribs, Groudine says.

Sometimes CPT includes revised codes that are obviously different from their previous versions. At other times, the revisions are so slight that it's easy to overlook the changes. That's the case with three revisions of interest to anesthesiologists and pain management practitioners, if CPT 2005 includes the expected descriptors:

34803 - Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis (two docking limbs). "Until now, the CPT code specifying two docking limbs was only offered as a Category III code (0001T)," says Debbie Gulledge, CPC, of Anesthesia Associates of Rockhill in Charlotte, N.C. "Now it's in the main CPT section and will be more easily accessible for coding."

63685 - Incision and subcutaneous placement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling will become Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling (underline added to show change).

"As basic as this may sound, you don't always insert and replace as the old code stated," Gulledge says. "The revised code gives you two case scenarios that accurately describe the procedure."

Previous versions of CPT did not include a code for replacement of a spinal neurostimulator pulse generator or receiver. That meant you were forced to bill with modifiers and submit paperwork to explain the procedure. The revised code will help you accurately report services when the physician replaces the device instead of performing the initial placement.

95971 - Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple brain, spinal cord or peripheral (i.e., peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming has one expected change that you might miss because it's buried in such a long descriptor. Instead of listing "simple brain" among the types of neurostimulators, 95971 will delete "brain" and read "simple spinal cord, or peripheral neurostimulator pulse generator/transmitter."

"The descriptor for 95970 states 'simple or complex brain,' " Gulledge says. "I believe the new wording is less repetitive than before."

Stick to Conscious Sedation Standards

CPT 2005 also includes seven new codes for upper GI endoscopy, laparoscopy, gastric restrictive procedures, flexible colonoscopy, and cystourethroscopy with transurethral resection or incision (43257, 43644, 43645, 43845, 45391, 43592 and 52402, respectively). These procedures all indicate conscious sedation (99141, Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation; and 99142, ... oral, rectal and/or intranasal), but few carriers reimburse for this service.

It's nice to be aware of the more descriptive codes, but you might only need them in rare instances (such as isolated cases of carriers whose systems still require surgical codes).

"Under HIPAA, all carriers should accept anesthesia code sets," Groudine says, which means you shouldn't need to report surgical codes for anesthesia services. "These new, specific surgical codes will help the surgeon but shouldn't affect our coding unless they cross to different anesthesia codes."