Anesthesia Coding Alert

Pain management specialists lose a little-used code

You'll need to hit the ground running with CPT Codes 2007 because you won't have a 90-day grace period for incorporating changes. Read on for a rundown on the changes -- including two new anesthesia codes and one anesthesia deletion -- that will affect your anesthesia and pain management coding most.

New OLV Codes Specify With Spinal Procedures   

CPT 2007 adds only two new codes to the anesthesia section, but you'll be glad to have them for spinal surgery cases:

• CPT 00625-- Anesthesia for procedures on the thoracic spine and cord, via an anterior transthoracic approach; not utilizing one-lung ventilation

• CPT 00626-- ... utilizing one-lung ventilation.

Tip: CPT's accompanying note points you to 00540 (Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm and mediastinum [including surgical thoracoscopy]; not otherwise specified) and 00541 (... utilizing one-lung ventilation) for nonspinal thoracotomy procedures. 

Until now, you didn't have a code for a transthoracic approach to spinal or spinal cord surgery. Having the new codes boosts your coding accuracy but also helps your anesthesiologist's bottom line: 00625 carries 13 base units instead of the 12 you reported in the past for 00540. Code 00626 carries 15 base units for one-lung ventilation.
  
Say Goodbye to 01995 

CPT added 01995 (Regional intravenous administration of local anesthetic agent or other medication [upper or lower extremity]) a few years ago, but you didn't use it if your physicians strictly focus on anesthesia rather than pain management (because you code based on the type of surgery rather than the anesthesia technique). Pain management coders sometimes used it to report blocks administered for pain relief.

Now you'll no longer need to worry about 01995 because CPT 2007 deletes it. The explanatory note reminds you to report the appropriate anesthesia code when your anesthesiologist uses regional IV administration of a local anesthetic or other medication in the patient's upper or lower extremity as the anesthetic during a surgical procedure.

When your physician administers a Bier block for pain management, the note indicates that you should report 64999 (Unlisted procedure, nervous system).

"This reminds people that the Bier block is just like a spinal or epidural," says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. "If the block is part of the anesthesia, then you code the anesthesia procedure instead of the technique. If the block itself is the surgical procedure (such as a steroid epidural or Bier block for reflex sympathetic dystrophy), report 64999 as the surgical code instead of an anesthesia code."

Watch Wording of Revised E/M Codes

If your physician performs inpatient consultations, be sure to check CPT 2007's revised wording for E/M codes 99251-99255.
 
Previous descriptors stated that these codes covered initial inpatient consultations. The updated descriptor simply says, "Inpatient consultation for a new or established patient ..."

Anesthesia example: An ICU patient with chronic renal failure develops acute respiratory distress syndrome 36 hours after mitral valve replacement surgery. Your anesthesiologist performs a consultation to help determine the best course of treatment. In this case, you would report consult code 92254.

Pain management example: A recovering drug addict is not getting relief from the patient-controlled analgesia (PCA) machine the surgeon ordered. The surgeon asks your anesthesiologist or pain management specialist to examine the patient and recommend treatment. Your physician provides an expanded problem-focused history and physical examination, and then makes recommendations for pain management changes that might result in a better patient outcome. You should report 99252 for the consult.

Caveat: Just because the descriptors no longer specify "initial" visit does not mean you can report 99251-99255 repeatedly for the same patient.

"Only one consultation should be reported by a consultant per admission," the section note explains. Instead, report the appropriate choice from 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...). Subsequent care codes include any services your physician performs to complete the initial consultation, monitor the patient's progress, revise his recommendations, or address a new problem.