Anesthesia Coding Alert

Tip: Focus on 99451 and 99452 and you’ll be fine.

Each year begins with a new set of Correct Coding Initiative (CCI) edits and the first version for 2019 is massive, with almost 46,000 new edits going into effect.

The good news: You don’t have many codes to sort through because the overwhelming majority of edits center on two new codes for 2019:

• 99451 – Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time
• 99452 – Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.

What it means: Codes 99451 and 99452 are always listed as the Column 2 code of the edit pair in question. This signifies that the services associated with 99451 or 99452 are considered integral to the other procedure being performed. You should only report the other service when applicable, not 99451 or 99452.

Also note: Every edit pair that includes 99451 or 99452 has been assigned a modifier indicator of “0,” so you cannot append a modifier to unbundle the pair and report both services.

As an anesthesia coder, you’ll see that virtually all anesthesia codes from CPT^® 2019 are paired with 99451 and 99452, once you reach the 006xx codes. A few examples to demonstrate the scope include:

• 00620 – Anesthesia for procedures on thoracic spine and cord, not otherwise specified
• 00870 – Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; cystolithotomy
• 01200 – Anesthesia for all closed procedures involving hip joint
• 01991 – Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); other than the prone position.

“I don’t anticipate anesthesia coders being in situations to report 99451 or 99452 for their patients undergoing anesthesia,” predicts Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I,  owner of Perfect Office Solutions in Leesburg, Fl. “The patient assessment is included in the base value for anesthesia services. The only potential time I could imagine these codes being used is if the patient had no anesthesia service and the anesthesiologist or CRNA had special training or knowledge that required a consultation between the treating physician and the qualified physician/CRNA. This would be way outside the norm, though.”

If you code for pain management services, you’ll find some of your go-to injection procedures also included in the edits. For example, you’ll report 62280 (Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid) or 62273 (Injection, epidural, of blood or clot patch) as the primary procedure instead of 99451 or 99452.

Important to know: In case you ever find yourself in a situation to report 99451 or 99452 as a stand-alone service, be cautious with your reimbursement expectations. Experts such as Melanie Witt, RN, MA, an independent coding consultant in Guadalupita, NM, stress that “It remains to be seen if payers will reimburse for these services as generally a face-to-face encounter is usually required. If the payer currently does not reimburse for interprofessional services, it is probably an indication that they will also not pay for these two new services.”

Don’t forget the deletions: The newest edits also include almost 20,000 deletions. In each case, the deletion is because one of the codes in the pair is no longer valid as of Jan. 1, 2019.

For example, code 64508 (Injection, anesthetic agent; carotid sinus (separate procedure)) has been deleted. Any previous edits involving 64508 are no longer in effect since you cannot report 64508.