Anesthesia Coding Alert

Plus: Don't miss chemodenervation changes for your pain management specialist.

Your top 2013 CPT® changes for anesthesia lie with the codes describing the patient's position during an injection procedure, and chemodenervation revisions every pain management provider will need to know. Get the scoop on how to adjust your reporting, come Jan. 1, 2013 when changes are effective.

Expand Your Provider Possibilities for 01991, 01992

CPT® includes only two anesthesia codes that specify how the patient is positioned during treatment: 01991 and +01992. The new descriptors for 2013 will be:

• 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
• +01992 -- ... prone position.

The difference: In previous years, the codes described anesthesia for an injection when administered by "a different provider" than the injection itself. Revised descriptors apply to "a different physician or other qualified health care professional."

"The descriptor change for 01991 and 01992 may be the AMA's attempt at being prepared for possible changes in the range of services that physicians, CRNAs, and other qualified healthcare professionals provide," says Tacy Brown, CPC, director of billing and compliance for Mountain West Anesthesia in Lehi, UT. "I would think it's difficult for CPT® to include in their descriptors the differences in the services that physicians versus other qualified healthcare professionals provide, as this varies from state to state."

Pump refill change: The descriptor for code 62370 also will also expand to include other qualified health care professionals instead of only physicians. If you code for pain management specialists, be aware of the revised descriptor:

• 62370 -- Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring skill of a physician or other qualified health care professional)

"Many mid-level providers already successfully manage implanted intrathecal pumps," says Anne M. Dunne, RN-BC, MSCN, MBA, director of healthcare consulting for Grassi and Co. in Jericho, N.Y. In that instance, providers report 62369 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming and refill).

"In New York State, there's a minor $5 difference in the Medicare fee schedule between codes 62369 and 62370," Dunne adds. "I suspect this new change will have little to no impact on how neurology practices manage this clinical service or the associated reimbursement they would budget."

Get Clarity for Chemodenervation Coding

CPT® 2013 clarifies longstanding questions regarding the correct usage of 64612. The code describes chemodenervation of muscles innervated by the facial nerve to treat conditions such as blepharospams (333.81, Other extrapyramidal disease and abnormal movement disorders; blepharospasm) or hemifacial spasm (351.0, Facial nerve disorders; Bell's palsy).

Opinions have varied regarding whether you can legitimately report 64612 multiple times if the physician performs chemodenervation on the facial nerve (cranial nerve VII) during the same encounter, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co. The Medicare Physician Fee Schedule (MPFS) lists 64612 as a code that allows bilateral reporting, but the revised descriptor for 2013 puts the question to rest: 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve, unilateral [e.g., for blepharospasm, hemifacial spasm]).

End result: You can report two units of 64612 if your physician administers chemodenervation to muscles innervated by the facial nerve on both sides of the patient's face. Indicate the situation on Medicare claims by appending modifier 50 (Bilateral procedure) to 64612. For non-Medicare payers, report 64612 on two separate lines with modifiers LT (Left side) and RT (Right side) appended.

"This helps immensely in clarifying the 'discrepancy' between Medicare's stance that 64612 could be reported as bilateral, and the AMA's stance that it would be reported only once for all injections," Hammer says.

Don't miss: In a similar revision, when CPT® 2013 goes into effect, 64614 will specifically represent chemodenervation to a single extremity. The new descriptor reads as follows: Chemodenervation of muscle(s); extremity and/or trunk muscle(s) (e.g., for dystonia, cerebral palsy, multiple sclerosis).