Anesthesia Coding Alert

The pain management codes were completely restructured in CPT 2000 (see Optimize Reimbursement for Tricky New Pain Management Codes, page 17 of Anesthesia Coding Alert, March 2000). Ideally, this should make choosing the best pain management code easier. Descriptors were expanded, new codes were added, and some old codes were consolidated into others. But does the restructuring really make a difference in the trenches? According to Jann Lienhard, a coder with Cash Flow Solutions, a medical billing and consulting company in Lakewood, N.J., anesthesia coders are still struggling with the pain management codes.

Document Thoroughly

Lienhard says that thorough documentation can help get claims paid. Keep good records and try to get written confirmation from the carrier about what theyll pay, Lienhard advises. Thats hard to do, because the carrier may say that their policies arent available for public distribution. Dont be afraid to make waves about it. No one can deny the surgery took place, so do your best to get paid for it.

Although practitioners have been providing pain management services for years, some carriers still tend to be wary of reimbursing for them. While Lienhard acknowledges that pain management is not as cut and dry as treating fractures or hernias, it is becoming a more important part of medicine. Most patients who see a pain management specialist have already run the gamut of other specialists, she says. We are the end of the line for these patients, or at least their last alternative before major surgery. Carriers will hopefully begin to recognize pain management as legitimate, as they eventually did with chiropractors, osteopaths and acupuncture specialists. In the meantime, the best we can do is document the cases thoroughly and be persistent about getting reimbursed for them.

Abdominal procedures are one such area, Lienhard says, can run a bit sticky. The anesthesia codes are not as specific as Id like them to be, she explains. Sometimes the anesthesia code that is cross referenced for a procedure just doesnt seem to be on par with what is done.

For example, code 50605 (ureterotomy for insertion of indwelling stent, all types), code 50320 (donor nephrectomy, open from living donor [excluding preparation and maintenance of allograft]) and code 50340 (recipient nephrectomy [separate procedure]) all cross reference code 00862 (anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper 1/3 of ureter, or donor nephrectomy) as the appropriate anesthesia code to use. But, as Leinhard points out, it seems that the anesthesia code for kidney donor or recipient procedures should be different from the code for inserting a stent to remove a urethral blockage.

Another scenario is when a physician performs multiple procedures on a patient. Multiple codes could be involved with what is done. The coder must choose which is the most accurate to list as the primary procedure, and how to document the other services for the most appropriate reimbursement.

Even if the most appropriate code may seem obvious to the anesthesia practice, insurance carriers may not interpret it the same way. Its not uncommon to have a carrier change opinions from one case to the next, says Cathi Turknett, office coordinator of Carolina Pain Consultants, a physician group in Statesville, N.C. Just because they approve a certain code for a procedure one week doesnt mean that the same carrier might not deny it for the same procedure on another patient two weeks later.

New Codes, New Reimbursement

The American Medical Associations (AMA) relative value update committee makes recommendations to the Health Care Financing Administration (HCFA) about the relative value units (RVUs) that should be associated with each procedure code. In the final Medicare Physician Fee Schedule for 2000, HCFA turned down eight of AMAs 16 recommended RVUs for pain injection codes. Many coding professionals see this as unfortunate for pain management practitioners since it can reduce reimbursement.

Each of the pain injection codes that were assigned lower-than-recommended RVUs is a new code for 2000. They are:

27096 (injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid)

62263 (percutaneous lysis of epidural adhesions using solution injection or mechanical means including radiologic localization)

62310 and 62311 (single injection [not via indwelling catheter], not including neurolytic substances, with or without contrast, of diagnostic or therapeutic substance; cervical/thoracic or lumbar, sacral)

62318 and 62319 (injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast, of diagnostic or therapeutic substance; cervical/thoracic or lumbar, sacral)

72275 (epidurography, radiological supervision and interpretation)

76005 (fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures, including neurolytic agent destruction).

Of course, the extent practices are affected by these RVU levels depends on how much of the practices business focuses on pain injections. As with all codes and reimbursement levels, contact your local Medicare carrier to verify the most appropriate codes to use in a given situation and the amount of reimbursement you can expect.