Anesthesia Coding Alert

Are we getting reimbursed for all the pain- management services we offer in our ambulatory surgery center (ASC)? Anesthesia providers and coding staff have been asking that question since April 1, 2000, when a long list of codes for spinal injection and treatment fell into a gray area for ASCs at least where Medicare was concerned. In May 2000, a HCFA program memo acknowledged all but nine of these codes as reimbursable for ASCs, because it considered them new procedure codes, not reclassifications of existing ones. Adding to the confusion, HCFA also proclaimed it would reimburse physician fees related to these procedures.

Providers will now get complete reimbursement for the procedures these codes cover. And anesthesia coders can recoup lost charges from 2000 and file correctly for procedures completed in 2001. (The codes involved are listed in the box below.)

However, just because HCFA has approved the codes for ASC use doesnt mean other carriers have, warns Joni Hyrick, executive vice president of Pain Treatment Centers of America in Buffalo, N.Y. Our carrier, Noridian (Blue Cross/Blue Shield of North Dakota), didnt have its software reprogrammed correctly for these codes until this year. Once they reprogrammed the software, we resubmitted claims from 2000 for these services and were reimbursed for most of them.

2001 Reimbursement Not Always Automatic

You should also be on the alert for other issues associated with HCFAs reversal. For example, Hyrick says that even though Noridian is paying most claims billed with these codes, it considers the procedure associated with code 62263 (definition below) as an experimental and unproven procedure and denies both the professional and ASC charges for it. The carrier has instructed providers to report the procedure with code 64999 (unlisted procedure, nervous system).

Workers compensation carriers, which tend to be a bit slower about accepting changes in policy, could present other problems. Some still use 1999 CPT codes instead of the 2000 or 2001 updates a providers paperwork nightmare. To address this issue, Hyricks group explains its use of the new codes by referencing the 1999 and prior codes on the narrative section of the claim form along with the most applicable current codes. If we forget to cross-reference the codes, well receive only partial payment for the service and then have to review and resubmit charges, she says, adding that this is true for both professional and technical charges in the states they serve.

Getting Paid for Denied or Outstanding Charges

Hyrick recommends working as soon as possible with local carriers to recoup delayed or denied reimbursement. Most practice management systems allow you to run a plan rebill report and automatically regenerate claims for resubmission when you outline the criteria, she explains. All centers with this capability should run a Medicare-specific program for the unpaid claims and resubmit everything to their carriers.

But Hyrick advises that it helps to have a good payer mix of commercial carriers to work with. Unfortunately, its difficult for ASCs to at best break even on Medicare patients because of poor reimbursement. And, because physicians all have different ideas about the appropriate level of care for their patients, youll have varying degrees of associated expenses. So, if Medicare rejects a service for payment, you could lose income not only for the procedure, but for the cost of providing what was necessary to perform it, she warns.

How much will resubmitting your claims affect the bottom line? It might not make much money, but many providers feel that every boost you give the bottom line
is helpful.

So, adjust payments for past services, attend to ASC claims submitted for current services billed with these nine codes, and most important, keep abreast of reimbursement changes whether youre an ASC, hospital, or private practice.

Accepted Pain-management Codes 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] 64470 injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level 64472 cervical or thoracic, each additional level 64479 injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level 64480 cervical or thoracic, each additional level 64483 ... lumbar or sacral, single level 64484 lumbar or sacral, each additional level 64626 destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level 64627 cervical or thoracic, each additional level