Anesthesia Coding Alert

Have no fear:  Most anesthesia changes should be common-sense edits to you

If you need to report CPT's new codes for anesthesia during abortion procedures, think twice before submitting separate claims for additional services.
 
The National Correct Coding Initiative, version 12.0, effective Jan. 1 through March 31, includes more than 200 new edits that apply to these procedures, plus it bundles numerous common procedures into anesthesia codes.

New Sedation Codes, Others Fall Under Anesthesia 

NCCI 12.0 categorizes 26 new procedure codes as components of virtually all anesthesia codes. These are nonmutually exclusive edits, which means you cannot charge for both services during the same encounter. The component codes are:

- 90760 and +90761--Intravenous infusion, hydration; initial, up to 1 hour and - each additional hour, up to 8 hours (list separately in addition to code for primary procedure)

- 90765 and +90766--Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour and - each additional hour, up to 8 hours (list separately in addition to code for primary procedure)

- 90772-90775--Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular; - intra-arterial; - intravenous push, single or initial substance/drug; and ... each additional push ...

- 99148-99149--Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports; under 5 years of age, first 30 minutes intra-service time and - age 5 years or older, first 30 minutes intra-service time. 
 
Considering these codes as components of anesthesia procedures makes sense to coders such as Jarrod Prater, an anesthesia coding analyst with Tulsa Hillcrest Anesthesiology Physicians in Oklahoma. -All the codes with this edit are obviously components of the anesthesia scenario,- he says.

New code clarification: Including the new sedation codes in these edits might help keep coders from inaccurately reporting them. -These new sedation codes definitely bring more specificity,- Prater adds. -You need a full understanding of these new codes because it might be easy to assign a code that would be inappropriate.-

Example: You would not be correctly using the new sedation codes 99148-99149 if you assigned them to a case the anesthesiologist performed under MAC (monitored anesthesia care). Instead, you should report the appropriate anesthesia code and append the correct MAC modifier (QS, Monitored anesthesia care service; G8, Monitored anesthesia care [MAC] for deep complex, complicated or markedly invasive surgical procedure; or G9, Monitored anesthesia care for patient who has history of severe cardiopulmonary condition).
 
New Abortion Codes Include All Related Services  

CPT 2006 introduced two new codes for anesthesia during abortion procedures: 01965 (Anesthesia for incomplete or missed abortion procedures) and 01966 (Anesthesia for induced abortion procedures). NCCI 12.0 indicates that these new codes include virtually any other service that might be performed with the abortion, such as:

- 01995--Regional intravenous administration of local anesthetic agent or other medication (upper or lower extremity)

- 01996--Daily hospital management of epidural or subarachnoid continuous drug administration

- 36600--Arterial puncture, withdrawal of blood for diagnosis

- 62280-62282 for neurolytic injections

- 62310-62311 for single-shot epidural injections

- 62318-62319 for continuous epidural injections

- 64400-64565 for nerve blocks.

One positive note: Even with so many common procedures listed as components of anesthesia during abortion procedures, NCCI 12.0 does not mention arterial line or Swan-Ganz catheter placements in the group. You can still report these services in addition to the anesthesia code with 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous), 36625 (- cutdown) or 93503 (Insertion and placement of flow-directed catheter [e.g., Swan-Ganz] for monitoring purposes).

Be Aware of Edits With New E/M Codes

In terms of E/M services, the edits also list all new E/M services as components of the anesthesia service:

- 99300--Subsequent intensive care, per day, for the evaluation and management of the recovering infant (present body weight of 2501-5000 grams)

- 99304-99337--Categories for initial or subsequent nursing facility care; and domiciliary, rest home or custodial care services. 

You won't typically rely on the new E/M codes for 2006, but you should still be aware of the edits, says Barbara Johnson, CPC, MPC, owner of Real Code Inc., in Moreno Valley, Calif. A pain management physician might conceivably visit a nursing home to refill a morphine pump or to check on one if the facility reported a problem. Most physicians, however, would probably have the patient brought into the office by ambulance instead.

-Overall, I don't anticipate much change or effects by these NCCI edits,- Prater says. -Most of the other information is reiterating things in some aspect, so these edits basically follow the same path as previous edits.-

For a complete list of edits, visit the CMS Web site.