Anesthesia Coding Alert

The Correct Coding Initiative (CCI) starts the year by changing modifier indicators, implementing edit pairs for new 2010 codes, and even switching column 1/column 2 designations for some pairs.

Version 16.0 is effective Jan. 1, 2010, and includes more than 69,000 active edits for anesthesia codes, according to information from Frank Cohen, MPA, of MIT Solutions Inc. in Clearwater, Fla. Read on for the most important highlights for your practice.

Thousands of new active edits go into effect Jan. 1, including many that pertain to anesthesia and pain management.

Paravertebral and somatic bundles: CCI 16.0 bundles virtually all anesthesia codes into new injection codes 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single level) and 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level).

Fluoroscopy changes: Bundles also kick in for anesthesia codes and fluoroscopy codes 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), 76001 (Fluoroscopy, physician time more than 1 hour, assisting a nonradiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]), and 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]). CCI 16.0 bundles 77002 into the above mentioned codes, but you can bypass the edit by reporting modifier 59 (Distinct procedural service). Experts caution, however, that you shouldn't automatically break the edit. Wait until a case when the injection is in conjunction with a completely different procedure so reporting both is more justified.

Injections and fluoro: New edits bundle another injection group, somatic nerve injection codes 64400-64455 (Injection, anesthetic agent ...), with 76000, 76001, 76998 (Ultrasonic guidance, intraoperative), and 77002.

Moderate sedation watch: Edits also pair new paravertebral facet joint injection codes 64490-+64495 with procedures ranging from fluoroscopy to electrocardiograms to evoked potentials tests. Moderate sedation codes 99148-99150 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports ...) are considered part of the paravertebral injection procedures and do not list a modifier bypass option.

Code pairs sometimes swap, with the column 1 and column 2 designations changing places. That's the case with anesthesia codes 00140, 00142, 01905, and 01922. The anesthesia code moves from column 1 to column 2 with procedures such as 92100 (Serial tonometry [separate procedure] with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day [e.g., diurnal curve or medical treatment of acute elevation of intraocular pressure]), 62280-62282 (Injection/infusion of neurolytic substance [e.g., alcohol, phenol, iced saline solutions], with or without other therapeutic substance ...), 62284 (Injection procedure for myelography and/or computed tomography, spinal [other than C1-C2 and posterior fossa]), and fluoroscopy codes 76000, 76001, and 77002.

One modifier indicator change applies to neurostimulator procedures 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling) and 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver). The modifier indicator changes from "0" to "1," breaking the previous rule saying you could not report the procedures together under any circumstances. CPT, however, states otherwise with the notation, "Do not report 63685 in conjunction with 63688 for the same pulse generator or receiver."

Explanation: Experts say that if your provider repositions the same generator, you cannot report both codes. If your physician removes one pulse generator and puts in another, however, you can submit both codes.

CCI 16.0 includes extensive terminated code pairs that affect every anesthesia code. Don't let the list worry you, however. "The deletions primarily involve codes that were either deleted from CPT 2010 or the consultation codes that are no longer covered by Medicare," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver.

The edits apply to deleted injection codes 64470 and 64475, plus consultation codes 99241-99245 (Office consultation for a new or established patient ...) and 99251-99255 (Inpatient consultation for a new or established patient ...).

New hope: As extensive as CCI 16.0 edits are, remember they only apply to payers that follow CCI. Many non-Medicare payers follow CCI edits when developing their bundling edits, but you can follow the American Medical Association's guidance when billing non-Medicare payers.

For example, CCI edits bundle 77002 into 64510 (Injection, anesthetic agent; stellate ganglion [cervical sympathetic]), but the AMA currently does not. Therefore, you can bill 77002 with 64510 if you're submitting to a non-Medicare payer that doesn't follow CCI edits.