Anesthesia Coding Alert

Updates focus on injection procedures.

September brings cooler temperatures and thoughts of autumn in many areas of the country, but in the coding world it also brings an official look toward the next year: the release of CPT^® coding additions, revisions and deletions.

If you code solely for anesthesia services, the CPT^® 2021 code book has no updates to the anesthesia section. You will need to pay attention to some things, however, if you code for pain management services.

Look Closely for These Revisions

Six injection codes are designated as revisions, with the familiar triangle icon in the margin beside the code and descriptor. They are:

• 64455, Injection(s), anesthetic agent and/or steroid; plantar common digital nerve(s) (eg, Morton’s neuroma)
• 64479, Injection(s), anesthetic agent and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, single level
• +64480, … transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, each additional level (List separately in addition to code for primary procedure)
• 64483, … transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level
• +64484, … transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

If you’re thinking that these descriptors are the same as what you’ve been accustomed to using, you’re correct. The revisions for 2021 aren’t related to the descriptor wording; they’re in the punctuation.

Look closely: The revisions include a semicolon to designate parent or root portions of the descriptors. For example, the semicolon in code 64455 denotes that the first part of the descriptor (“Injection(s), anesthetic agent and/or steroid”) is the descriptor root and the portion following the semicolon (“plantar common digital nerve(s) (eg, Morton’s neuroma))” is what distinguishes the code from other procedures in the code family with the same root.

“The revision might have been made for consistency,” says Kelly D. Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida. “If you look at codes 64486 (Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)) and 64488 (Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)), the punctuation separator is a semicolon, not a comma.”

Say Goodbye to These Category III Codes

Four Category III codes will mark what would have been their tenth year in existence by being deleted from CPT^® 2021. They are:

• 0228T, Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level
• 0229T, … each additional level (List separately in addition to code for primary procedure)
• 0230T, Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level
• 0231T, … each additional level (List separately in addition to code for primary procedure)

“We continue to see fluoroscopy and CT as easily the most common modalities of image guidance for transforaminal epidurals – well above ultrasound guidance,” says Cindy Hinton, CPC, CCP, CHCC, owner of Advanced Coding Solutions, LLC, in Nashville, Tenn. “This would obviously affect usage of these codes in comparison to codes 64479 through 64484. That would have been a primary consideration in determining whether the Category III codes were still needed.”

Refresher: The AMA develops Category III codes to track the utilization of emerging technologies, services, and procedures. They are included on claims for data collection and general information purposes but are not reimbursable.

Several other Category III codes of interest to anesthesia and pain management are among those scheduled to “sunset” in 2021, such as:

• 0213T, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level
• +0214T, … second level (List separately in addition to code for primary procedure)
• +0215T, … third and any additional level(s) (List separately in addition to code for primary procedure)
• 0216T, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level
• +0217T, … second level (List separately in addition to code for primary procedure)
• +0218T, … third and any additional level(s) (List separately in addition to code for primary procedure)

“Saying codes are scheduled to ‘sunset’ means their usage and demand will be reviewed,” Hinton explains. “They might be renewed as Category III codes if warranted, or they might be replaced by Category I codes that would then make them eligible for reimbursement. However, if they are no longer needed or if the service described has become obsolete, they may be archived.”

Don’t Gloss Over the E/M Overhaul

Much of the buzz leading up to 2021 code release centered on the evaluation and management (E/M) code section, which will see its first major overhaul in more than 25 years.

Coders who report pain management services will need to get familiar with the E/M shifts, which include:

• Eliminating history and physical exam as elements for code selection.
• Allowing physicians to choose the best patient care by permitting code level selection based on medical decision making (MDM) or total time.
• Promoting payer consistency with more detail added to CPT^® code descriptors and guidelines.

According to the AMA, the modifications were designed to make E/M office visit coding and documentation simpler and more flexible, freeing physicians and care teams from clinically irrelevant administrative burdens that led to time-wasting note bloat and box checking.

“To get the full benefit of the burden relief from the E/M office visit changes, health care organizations need to understand and be ready to use the revised CPT^® codes and guidelines by Jan. 1, 2021,” said AMA President Susan R. Bailey, MD. “The AMA is helping physicians and health care organizations prepare now for the transition and offers authoritative resources to anticipate the operational, infrastructural, and administrative workflow adjustments that will result from the pending transition.”

The same holds true for code changes in other sections of the CPT^® 2021 code book. Take this beginning-point information to heart and start prepping your team now to code successfully in 2021.