Anesthesia Coding Alert

The anesthesia section of CPT 2008 may only include a few changes, but they'll make a real difference in your coding -- especially if your physicians provide anesthesia during imaging procedures. Here's the scoop.

Beginning in January, you'll add two more possibilities to your spinal coding options:

Under CPT 2007, you usually reported 01905 (Anesthesia for myelography, discography, vertebroplasty) for this type of guided imaging. CPT 2008 deletes 01905, however, so you'll no longer have that option. You also might have reported 01922 (Anesthesia for non-invasive imaging or radiation therapy), but the new additions will help you report the procedures in more detail.

With the deletion of 01905, "these new codes are necessary; otherwise, you might have to use the 00600 series for these procedures," says Scott Groudine, MD, an anesthesiologist in Albany, N.Y.

Why that wouldn't work: The additions make for more accurate coding because procedures represented by the 00600 series (codes for anesthesia during spine and spinal cord procedures) don't really fit into 01905. Most of the codes in the 00600 series have 7 to 15 base units, which is too high for a percutaneous procedure.

"These procedures are not lumbar taps (00635, Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture) or close manipulations (00640, Anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic or lumbar spine)," Groudine says. "The new codes more accurately describe an increasing type of anesthesia procedure. They fill a void the deletion of 01905 exacerbated."

What they include: You'll report 01935 and 01936 for guidance during the same procedures you formerly reported with 01905: myelography, discography and vertebroplasty. You might also use 01936 when your anesthesiologist uses fluoroscopic guidance for an epidural catheter placement, says Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif. You could also use 01935 for ultrasound guidance during a bone marrow or vertebral biopsy, she adds.

CPT revises only one anesthesia code -- 01931. Terminology in the descriptor's example changes from "transcutaneous porto-caval shunt (TIPS)" to "transvenous intrahepatic portosystemic shunt(s) (TIPS)."

The complete descriptor now reads: 01931, Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); intrahepatic or portal circulation (e.g., transvenous intrahepatic portosystemic shunt[s] [TIPS]).

Advantage of change: The revision won't change your use of the code but makes the descriptor more accurate in terms of your anesthesiologist's work and the approach he uses during the procedure.

If your physician routinely bills for phone calls to patients or to coordinate care with other medical professionals, be sure to check out changes in the E/M section.

E/M deletion: CPT 2008 deletes codes 99371-99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals [e.g., nurses, therapists, social workers, nutritionists, physicians, pharmacists] ...).

Replacement codes: You have three new time-based codes for similar services to patients:

"Coders will need to watch the stipulation of having the service provided 'within the previous 7 days or leading to an E/M service,' " Johnson says. "You'll need good documentation of the timing to be sure this code still applies."

A similar option is available for technology-savvy physicians who offer online E/M services: 99444 (Online evaluation and management service provided by a physician to an established patient, guardian or healthcare provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network).

The E/M section includes four other new codes similar to those listed above, but with a catch: they represent services by a "qualified nonphysician healthcare professional."

Will you need to become familiar with these additions? Probably not, if your physicians concentrate on surgical anesthesia. But if your group specializes in pain management, these codes may help.

"Pain management coders will use these codes when coordinating care with orthopedists and neurosurgeons," Johnson says. "While anesthesia will most likely not use these codes much, pain management could find them very helpful."