Anesthesia Coding Alert

The Correct Coding Initiative (CCI) edits 7.2 released in July 2001 included many changes to mutually exclusive codes for pain management.
 
Mutually exclusive codes are for services that cannot be reasonably performed in the same session. Many of these codes would not usually be billed together, so the bundlings have little impact on current billing procedures.
 
A physician may attempt to reposition a patient's existing epidural catheter (62350) but is unable to do so. Instead, the catheter is removed (62355). Because both procedures are mutually exclusive, only one can be billed.
 
The following are CCI edits 7.2 for pain management:
 

Aspiration or decompression of nucleus pulposus of intervertebral disk (62287): This procedure now includes 62310, 62311, 62318, 62319, 64479 and 64483. Mary Jo Marcely, CPC, chief operating officer of the anesthesia and pain management consulting firm FM Services in Syracuse, N.Y., points out that this is an important edit because some carriers want practitioners to use 62287 for reporting intradiscal electrothermal therapy (IDET) or laser assisted spinal epidurolysis (LASE) procedures, which are becoming more common.
 

Epidural or subarachnoid injections and catheter placement (62310, 62311, 62318, 62319): Several codes have been bundled with each of these procedures, including 20605, 20610, 36140, 62284, 64483, 76000 and 76005. Being aware of these bundlings is especially important since the primary codes of 62310, 62311, 62318 and 62319 are bundled into so many other procedures.
 
"I'm not surprised the epidural codes 62310 and 62311 are mutually exclusive with the transforaminal codes 64479 and 64483," states Gail Kaye, CPC, a coder with the consulting firm Webster, Rogers and Co., LLP, in Florence, S.C. "I had the opportunity to observe and question a physiatrist who had asked what protocol had been established for billing these codes and if it was proper to bill for both procedures at the same level during the same session. He explained that with the transfora-minal procedure you would hope to achieve good epidural flow, and he did not feel it was appropriate to bill for both. His school of thought was different from that of his colleagues, who felt if both were performed, the physician should bill for and get reimbursed for both. I suspect there have been some differences of opinion and interpretation over the use of these new spine codes since they first came out in January 2000. This new CCI edit ends the debate so both cannot be billed simultaneously.
 
"If an injection is provided at a different level or at a different site (such as a trigger point or joint injection at the knee or shoulder)," Kaye adds, "then modifier -59 (distinct procedural service) should be appended to indicate that the procedure was performed at a different site."
 

Implantation and removal of intrathecal or epidural catheter for infusion pump (62350, 62351, 62355) and implantation and removal of infusion pump (62360, 62361, 62362, 62365): Codes 62310, 62311, 62318, 62319, 64479 and 64483 have been bundled with these procedures related to infusion pumps.
 
Kaye notes that in the practices she follows, these injection codes were never used in conjunction with the codes for pump implantation, but other practices that may have billed both codes must know of the change. The edits state that the anesthesia is included in the surgical procedure.
 
"Education is key to incorporating the edits," Marcely says. "I spent many hours educating physicians and staff on the edits and how they will affect their practices from clinical and reimbursement points of view. Pain practitioners must get involved with state and local societies to help defend the specialty and protect it from unfair edits and reimbursement obstacles."
 
As new edits are introduced each quarter, many coders find it difficult to keep abreast of changes. But, as Kaye states, "In my opinion, the CCI edits provide additional clarification and direction for use of all the new spine codes published in January 2000. It takes time for physicians and health plans to implement and understand how the new codes apply to the coding structure, to determine what is inclusive, etc. This is just part of the process of being sure services are coded accurately."
 
Note: For information on changes to comprehensive and component codes for pain management, see the September 2001 issue of Anesthesia and Pain Management Coding Alert.