Anesthesia Coding Alert

2015 will bring several new options specific to anesthesia providers. 

If you regularly report TAP catheters, your new options will allow you to...

Read on for how to apply this and other CPT® 2015 changes to your day-to-day coding life. 

Find Replacements for 3 Anesthesia Codes 

You’ll no longer be able to report three codes from CPT®’s anesthesia section in 2015 because they’ll be deleted:

• 00452 – Anesthesia for procedures on clavicle and scapula; radical surgery
  
• 00622 – Anesthesia for procedures on thoracic spine and cord; thoracolumbar sympathectomy
  
• 00634 – Anesthesia for procedures in lumbar region; chemonucleolysis. 
  

“When the deletions go into effect, coders will simply report the highest based procedure that matches anatomically,” says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. 

For example, you’ll report 00620 (Anesthesia for procedures on thoracic spine and cord; not otherwise specified) to a not otherwise specified/NOS location; 00625 (Anesthesia for procedures on the thoracic spine and cord, via an anterior transthoracic approach; not utilizing 1 lung ventilation) for an anterior approach not using one lung ventilation; 00626 (…utilizing 1 lung ventilation) for using one lung ventilation; or 00670 (Anesthesia for extensive spine and spinal cord procedures [e.g., spinal instrumentation or vascular procedures]) if the thoracic spinal procedure involved multiple levels (as described in the comments section or instrumentation).  

Learn Your New TAP Block Coding Options 

Providers sometimes use transverses abdominis plane (TAP) catheters as an alternative to epidural analgesia after upper abdominal surgery or as an adjunct to anesthesia during an abdominal laparoscopic procedure. CPT® currently doesn’t include a code specifically for a TAP catheter, so you report the service with 64999 (Unlisted procedure, nervous system) and submit a copy of the procedure report. That will change in 2015, when you’ll have access to four new codes that differentiate between an injection or continuous infusion and whether the provider administered a unilateral or bilateral injection. 

The new options will be: 

• 64486 – Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed) 
  
• 64487 – … by continuous infusion(s) (includes imaging guidance, when performed) 
  
• 64488 – Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed) 
  
• 64489 – … by continuous infusions (includes imaging guidance, when performed). 
  

“I expect the confusion regarding TAP block coding go away since we’ll now have specific codes,” Dennis says. 

Add Another Choice for TEE Monitoring 

Anesthesiologists sometimes use TEE (transesophageal echocardiography) for monitoring during cardiac procedures. If your provider’s documentation supports the criteria, you can sometimes report 93318 (Echocardiography, transesophageal [TEE] for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing [continuous] assessment of [dynamically changing] cardiac pumping function and to therapeutic measures on an immediate time basis) for the service.

Change: Beginning in 2015, you’ll have an additional, more comprehensive code for TEE monitoring. Code 93355 will represent “Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (e.g.,TAVR, transcathether pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure) (peri-and intra-procedural), real-time image acquisition and documentation, guidance with quantitative measurements, probe manipulation, interpretation, and report, including diagnostic transesophageal echocardiography and, when performed, administration of ultrasound contrast, Doppler, color flow, and 3D.” 

Remember: Medicare does not pay for TEE monitoring. Dennis advises coders to look for documentation that shows who performed the service and fully explains the procedure and service (diagnostic, monitoring, Doppler echocardiography with or without color flow, etc.). 

Watch for Kyphoplasty, Vertebroplasty Code Overhaul

If you code for pain management services, your provider will report kyphoplasty and percutaneous vertebroplasty services differently in 2015. That’s thanks to six new codes that will represent the services based on the number of vertebral bodies treated and the spinal area: 

• 22510 – Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic 
  
• 22511 – … lumbosacral 
  
• +22512 – … each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure) 
  
• 22513 – Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic 
  
• 22514 – … lumbar 
  
• +22515 – … each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure). 
  

Important: Note that each code will continue to represent both unilateral and bilateral injections.

“It’s important to see that the new vertebroplasty code, 22510, also includes the cervical spine region,” says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver, Co. “If a provider performs a cervical vertebroplasty in 2014, you can only report it with 22899 (Unlisted procedure, spine). It will be good that pain management providers will be able to report the cervical procedure with the new 22510 code.” 

These codes will replace your current options, 22520-22525. The biggest change is the addition of “inclusive of all imaging guidance” to the descriptors. Each of the new codes also includes the “bulls-eye” symbol designation, which means the associated RVUs and service include moderate sedation. This is new for kyphoplasty in 2015. The 2014 codes (22523-22525) did not include moderate sedation, so you could bill it separately. 

Because of the updated descriptors, the associated radiology codes for guidance will be deleted. You’ll no longer be able to report the following codes as part of your vertebroplasty or kyphoplasty claim: 

• 72291 – Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance 
  
• 72292 – … under CT guidance. 
  

Editor’s note: See Anesthesia Coding Alert, Vol. 16, No. 10 for an overview of the  new and revised CPT® codes that will go into effect for anesthesia on Jan. 1, 2015.