Anesthesia Coding Alert

The predicted epidural changes might become reality.

The AMA has released pre-production information about the probable changes to CPT^® 2017. At this point, it looks like the update will include approximately 140 new codes, with about 40 of those falling into Category III. We can’t publish specifics at this point, but here’s a rundown of the types of changes you might see in January.

Epidurals Get New Additions

There’s been talk in the recent past of overhauling the choices for epidural injections, It looks like 2017 could be the year you see that happen, with the new descriptors adding details that codes such as 62310 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic) don’t have.

Example 1: Instead of copying the phrasing “not including neurolytic substances, including needle or catheter placement,” some of the newly proposed codes read as, “not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid.”

Example 2: You’ve spent years reporting codes such as 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid]) if your physician used fluoroscopic guidance during epidural placement. Now it looks like the new epidural codes specify either “without imaging guidance” or “with imaging guidance (i.e., fluoroscopy or CT).”

As a counterpart to that, guidance codes 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) and 77003 will have some minor revisions as well. Each code will be designated as an add-on and will include the standard “List separately in addition to code for primary procedure)” verbiage as a reminder of how to use it correctly.

Moderate Sedation Time Frames Change

Anesthesia providers don’t often qualify for reporting one of the moderate sedation codes, but you’ll still want to be aware of the applicable codes. The CPT^® “sneak peek” includes six new moderate sedation options that are based on 15-minute increments of intraservice time rather than the 30 minutes associated with current base codes such as 99149 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age 5 years or older, first 30 minutes intra-service time).

The new codes also leave out the “other than those services described by codes 00100-01999” detail. 

Heads up: Digging into the initial list of changes can be confusing because some codes that are marked as revisions for 2017 have the same descriptor that’s currently in place.

“Perhaps they changed the RVUs, which aren’t listed,” suggests Kelly Dennis, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. We’ll have to wait a few more months to learn those final details.