Anesthesia Coding Alert

Revised directions change ultrasound, T12-L1 reporting.

Remember to check for updated or revised guidelines when preparing to use your new code books for 2011, not just code descriptors. CPT 2011 includes new details for coding some common injection procedures, as pointed out at the AMA's CPT and RBRVS 2011 Annual Symposium in Chicago. Read on for a few pointers to help stay on the right track.

Check Revised Paravertebral Injection Notes

The introduction of new codes for paravertebral facet joint injections in 2010 (64490-64495) meant changes to how you reported related codes. During the CPT and RBRVS Symposium, Douglas G. Merrill, MD, MBA, of the American Society of Anesthesiologists, pointed out two revised guidelines dealing with paravertebral facet (spinal) joint procedures.

Ultrasound clarification: Instructions in CPT 2010 directed you to report 64999 (Unlisted procedure, nervous system) if the provider used ultrasound guidance during paravertebral facet joint injections. The AMA released a correction later in 2010, and the CPT 2011 clarifies the situation. If your provider used ultrasound guidance when administering paravertebral facet joint injections, report the appropriate code(s) from 0213T-0218T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance ...).

T12-L1 change: CPT 2010 guidelines mandated that you report 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) for an injection to the T12-L1 joint, or nerves innervating that joint. New 2011 guidelines direct you to submit 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single) instead.

In addition, the 2011 guidelines direct providers to report paravertebral facet joint injections performed without image guidance with the appropriate trigger point injection code. Submit either 20552 or 20553 (Injection[s]; single or multiple trigger point[s]...) rather than from the 20550 -- 20553 code range as directed for 2010.

Reminder: Code paravertebral facet joint blocks (64490-64495) bilaterally if the physician injects two sides at the same level. "These are unilateral blocks," Merrill explained. Use modifier 50 (Bilateral procedure) for bilateral paravertebral facet injection procedures.

Take Care When Reporting Somatic Nerve Injections

Merrill noted three somatic nerve injections identified through CMS's "Fastest Growing" screen:

• 64415 -- Injection, anesthetic agent; brachial plexus, single
• 64445 -- ... sciatic nerve, single
• 64447 -- ... femoral nerve, single.

"Increased utilization can be indications of incorrect coding," explains Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co. "These may become target areas for the OIG Workplan, such as facet joint injections and transforaminal epidural injections have been in recent years."

Application: Anesthesiologists who provide acute post-operative pain management services are likely to rely on the three codes. Look to 64415 for shoulder and/or upper extremity surgery care and either 64445 or 64447 following lower extremity surgery.

Wait and see: Merrill indicated during the workshop that information to clarify correct coding is forthcoming. Watch for details from the AMA and in future articles of Anesthesia Coding Alert.