Anesthesia Coding Alert

Ambulatory payment classifications (APCs) finally went into effect Aug. 1, amidst much confusion from caregivers on all fronts. Hospitals had to set up new systems for coding and learn an entirely new set of codes, and many of the ins and outs related to coding changed. The changes that affect anesthesia, particularly in the area of pain management, can be addressed with three key questions:


1. How will pain practices be affected? The financial impact for pain management is not completely known yet, although experts in the field agree that changes are on the way.

A number of codes related to anesthesia procedures are likely to be affected, according to Carlos Girn, MD, a pain management anesthesiologist with the physician group The Georgia Pain Institute in Macon, Ga. These include codes such as 62263 (percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., spring-wound catheter] including radiologic localization [includes contrast when administered]); 64479 (injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level) and related codes 64480-64484; and 64470 (injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) and related code 64472 for each additional level.


2. Whats covered and whats not? The new guidelines clearly indicate that some pain procedures that have been covered in the past no longer will be. On the flip side, some procedures that were not covered in the past now are.

For example, procedures such as implantation of neurostimulator systems (64590, incision and subcutaneous placement of peripheral neurostimulator pulse generator or receiver, direct or inductive coupling) were not covered in the past; now they will be. And a long list of epidural-related codes that were sanctioned through previous versions of CPT (such as 62274, 62275, 62276 and others) will no longer be covered because they have been deleted from CPT.


3. Where do we go from here? A series of deadlines has walked coding professionals and caregivers through the process of implementing the new APCs since the final rule was published in the Federal Register in March. The final deadline for the process this year is Nov. 30, when co-payment discounts for 2001 will be determined. The Health Care Financing Administration (HCFA) will determine these discounts and will advise practitioners of details related to them.


As with any major change in the coding world, the establishment of APCs comes with a high learning curve for everyone involved. Some practitioners expect their work to be greatly affected by the changes. Others, such as Donna Howe with the independent practice group Anesthesiology Associates of Eastern Connecticut in Manchester, Conn., are not so sure. The physicians in my group were very concerned because they had heard through the grapevine that anesthesia services would become part of the APC packaged service, she says. I attended a workshop presented by a consulting group in Massachusetts, and there was a great deal of confusion with regard to how APCs would affect independent practitioners. We were told that APCs would not affect independent practitioners at all. The consultants said that the only physicians who would fall under the APC guidelines were the ones who were hospital employees. I was told that reimbursement for anesthesia services would not change.

Girn recommends that anesthesia professionals work closely with The American Society of International Pain Physicians (ASIPP, formerly the Association of Pain Management Anesthesiologists) or another professional pain organization to learn about the new system and find ways to still receive appropriate reimbursement for pain management services provided. Representatives from these organizations have worked with HCFA staff and other Washington representatives to develop the changes being implemented.

APCs were implemented to reduce or direct reimbursement more accurately, Girn says. Practitioners and coders should check different pain associations Web sites and keep abreast of news in the Federal Register so they can file claims appropriately.