Anesthesia Coding Alert

"Aponeurosis" is a sheetlike fibrous membrane that resembles a flattened tendon and binds muscles together or connects muscle to bone. Many coders had problems determining whether to use 20550 or 20551 for procedures, so revising the codes helps clarify their use.
 
"I believe some coders were confusing 20551 with aponeurosis since it deals with the means of origin or insertion of a muscle," says Debbie Gulledge, CPC, a coder with Anesthesia Associates of Rock Hill in Charlotte, N.C. Now CPT clearly spells out that you code aponeurosis with 20550.
 
Pain physicians often administer multiple injections to a single muscle or tendon to achieve better results. The old descriptor possibly indicated that the provider could only bill 20551 one time per session, even if he administered multiple injections. The descriptor change suggests that you can bill multiple units of 20551 if the physician injects separate tendon origins or insertions.
 
For example, a patient falls from a ladder and lands on his left ankle, which gives way beneath him. The patient then falls onto his side and hits his left shoulder. His physician might perform a tendon origin/insertion injection to the left Achilles tendon insertion, and a separate and distinct injection into the patient's left biceps tendon insertion. Simply adding the word "single" to 20551's descriptor means the physician in this scenario can bill both services and remain compliant. If you see this type of scenario, append modifier -59 (Distinct procedural service) to the second injection to indicate that the physician performed two different services.
 
The revised descriptors for 20552 and 20553 (... single or multiple trigger point[s], three or more muscles) were big news in CPT 2003 and changed how you reported some services; this year's change simply makes 20552 and 20553 non-indented codes. "People hopefully understand how to correctly report trigger point injections by now," Gulledge says. "If your providers routinely perform trigger point injections and you have current coding resources available, you shouldn't be as confused about reporting TPIs. You just need to pay close attention to the number of muscle groups involved."
 
CPT 2004 also amends the definition of 64680 (Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus). This is more of a restructuring change than a big descriptor change (the old descriptor included "celiac plexus" in the middle instead of separating it at the end with a semicolon.
 
"Using the semicolon to set it apart will more clearly designate the treatment area," Gulledge says. It's also a first step toward adding other indented codes for treating other areas, adds Barbara Johnson, CPC, MPC, anesthesia coder with Loma Linda University Medical Anesthesiology Group in Loma Linda, Calif. New code 64681 is Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus. Because both of these descriptors include the phrase "with or without radiologic monitoring," they include fluoroscopy as part of the procedure.

Myelography and Pump Maintenance Codes

CPT 2003 included four codes for supervision and interpretation of myelograms - one each for cervical, thoracic or lumbar areas as well as one for the entire spinal canal. Now CPT 2004 revises 72270's definition to state, "Myelography, two or more regions (e.g., lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical." Providers regularly perform myelograms in more than one area, and CPT's revision of 72270 will simplify your coding. Now you'll report one code for the service instead of reporting multiple codes if the physician treated more than one region but not the entire spinal canal.
 
For example, consider a patient with disk herniations in the C6-C7 range. The physician may perform myelography of the cervical region and into the thoracic region to diagnostically document any further cord impingements. Code 72270 covers the situation without requiring additional codes.
 
When you report pump refill or maintenance, check out 95990 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular]) and 95991 (...  administered by physician). Patients' pumps often need to be refilled, and Johnson says that nurses usually perform the service (which you report with 95990). But some physicians prefer to refill the pumps themselves, so adding 95991 gives more details about the service when this is the case.
 
Carriers that abide by NCCI (National Correct Coding Initiative) guidelines will only reimburse for pump refills in a hospital setting if the physician does the refill, so reporting new code 95991 will make claims processing easier in those cases. Include a copy of the case notes with the claim to verify the physician's role in the procedure. Watch for updated base unit allowances from the ASA and Federal Register to learn if the new code also gives the physician additional allowance for doing the work himself.

Add Two New Injection Codes to the Mix

Two new injection codes will also interest pain management practitioners because they offer more specific descriptions for the procedures: