Anesthesia Coding Alert

Adjusting to updated codes and guidelines in CPT Codes each year can be challenging for anesthesia coders. This has been especially true this year, with so many pain management codes deleted, added or modified in CPT 2000. Some coding professionals have faced the additional challenge of being denied reimbursement for procedures that are coded correctly, because of an error in the Health Care Financing Administrations (HCFAs) carrier tapes. But there are steps you can take to receive appropriate reimbursement.

Which Codes Are Affected?

CPT 2000 introduced a series of new or revised codes for pain management physicians to use when reporting spinal injections. These codes (which are outlined below) are considered to be unilateral procedures. They should be reported using modifier -50 (bilateral procedure) in addition to the procedure code if they are performed bilaterally.

The initial HCFA carrier tapes for 2000 contained an error that made the system reject any claims using some injection codes with modifier -50. These included 64470, 64472, 64475, 64476, 64479, 64480, 64483 and 64484 representing single or additional level injections of anesthetic agent and/or steroid to the cervical/thoracic or lumbar/sacral area and 64622, 64623, 64626 and 64627 representing destruction of neurolytic agent, paravertebral facet joint nerve, single or additional level, to the lumbar/sacral or cervical/thoracic area.

Neither of the reasons given for the rejections was valid, says Laura Ciarvino, CCS, a medical coder with Watson Clinic, a multispecialty physician group in Lakeland, Fla., that includes seven anesthesiologists and seven certified registered nurse anesthetists (CRNAs.) The system would give one of two reasons for denial, she says. One reason given was that the code was for a unilateral procedure, and there was another code when it was performed bilaterally. The other was that the relative value units were already based on the procedure being bilateral. Neither of these reasons was right, so there are lots of denials in the system that people are trying to get reimbursed for.

What Now?

HCFA recognized its error earlier in the year and took steps to correct the tapes. New tapes with the correct information are to be distributed to local carriers as part of the next HCFA update. Once the new tapes are out, claims processed with modifier -50 should go through without a problem as long as there is documentation showing the injections were performed bilaterally.

Some anesthesia coders say that all pending claims should be processed correctly once HCFA has corrected the error. Others say Medicare will not take the initiative to correct claims already filed that were denied improperly. Anesthesia providers who received denials have two options for seeking reimbursement:

1. Submit the claims with modifier -50, receive denials and appeal the decision once your local carrier has the updated instructions from HCFA. Anesthesia providers should remember that HCFA wants all bilateral procedures billed on one line with modifier -50.
2. Hold all the claims until your local carrier has the new HCFA instructions, then file everything together.

Be sure you have the documentation to support any appeal. If Ciarvino bills a code with a track record of reimbursement problems, she submits the claim with the operative report, a brief letter explaining why they chose to bill that way, and any supporting documentation with pertinent information highlighted. For example, one of her reference books mentions that codes 64470-64484 are unilateral procedures that should be billed with modifier -50 if they are performed bilaterally. She photocopies this information and submits it with the claim.

Before attempting to receive reimbursement for these situations, make sure your local carrier has the new HCFA corrections. Call your local carrier to see if they have the updated tapes and can handle modifier -50 correctly with these codes, Ciarvino advises. Once you know they can handle the claims, it probably will be to your advantage if you can batch your claims when you submit them. If you have lots of rejections from earlier in the year, send them all in at once when you appeal them. If youve been holding on to claims until your carrier has the updated tapes, send everything to them at the same time.

Many coders and anesthesia providers agree that sending claims in batches is easier because you only have to explain to one person, and it saves time and money. The claims will all get accepted or denied, instead of some getting paid and others needing additional attention. By communicating with your carrier and ensuring they can process the claims correctly before you submit them, your chances of getting reimbursed for pain procedures with modifier -50 should be greatly improved.