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Anesthesia Coding Alert

NCCI 10.0 Starts the Year With Lots of Anesthesia Edits

Published on Fri Jan 02, 2004

Hundreds of procedures are bundled into the new anesthesia codes

The latest version of the National Correct Coding Initiative (NCCI) includes hundreds of edits affecting anesthesiologists. Most notably, the NCCI bundles gastric tube placement and lumbar and hypogastric plexus nerve blocks into virtually all of the anesthesia codes. NCCI version 10.0 - which took effect Jan. 1, 2004 - bundles the following three surgical codes into nearly all anesthesia procedures:

  •  43752 - Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)

  •  64449 - Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration

  •  64517 - Injection, anesthetic agent; superior hypogastric plexus.

    Both 64449 and 64517 are new codes that CPT 2004 introduced. Prior NCCI versions already bundled most other nerve block codes into anesthesia services.
     
    "All bundling is done to prevent inventive ways to bill for increased revenue when those procedures are part of routine care," says Barbara Johnson, CPC, MPC, an anesthesia coder in Loma Linda, Calif. "These codes are probably bundled since they're very usual procedures. I actually don't see why 43752 wasn't bundled with other codes years ago."
     
    In addition, NCCI 10.0 bundles 64449 into the anesthesia codes because you should report 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) for daily care following catheter placement instead, Johnson says.

    Watch Whether Edits Bundle All Three Codes

    NCCI 10.0 bundles 43752, 64449 and 64517 into too many anesthesia codes to list all of the pairings. There are, however, some instances when the NCCI bundles only one or two of these surgical codes into an anesthesia procedure. Watch for these and other grouping variations to ensure that you're not assuming that procedures are bundled when they're really separately billable:

  • Only 43752 is bundled into codes 00834, 00836, 01920, 01922, 01953 and 01990.

  • Codes 43752 and 64449 - but not 64517 - are bundled into anesthesia procedures 00840, 00842, 00844, 01930.

  •  Codes 43752 and 64517 - but not 64449 - are bundled into 00921, 00928, 01840.

    New Anesthesia Codes Get Paired With Many Procedures

    The NCCI also bundles many procedures into the new anesthesia codes 00529 (Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy utilizing one-lung ventilation), 01173 (Anesthesia for open repair of fracture disruption of pelvis or column fracture involving acetabulum) and 01958 (Anesthesia for external cephalic version procedure).
     
    Many procedures are now components of these new codes. These range from anesthesia codes 01995 (Regional intravenous administration of local anesthetic agent or other medication [upper or lower extremity]) and 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) to surgical procedure codes 36000 (Introduction of needle or intracatheter, vein); neurolytic substance injection/infusion codes 62280, 62281 and 62282; and many electrocardiogram, stress test and other cardiography service codes.

    Edits Also Bundle Some Anesthesia Codes With Category III Codes

    The edits also list a few anesthesia codes as components of some new Category III procedures. The affected codes are: 

  • Code 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) is included in surgical procedures 0046T (Catheter lavage of a mammary duct[s] for collection of cytology specimen[s], in high-risk individuals [GAIL risk scoring or prior personal history of breast cancer], each breast; single duct) and 0047T (... each additional duct).

  • Codes 00520 (Anesthesia for closed chest procedures; [including bronchoscopy] not otherwise specified) and 00740 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum) are components of 0057T (Upper gastrointestinal endoscopy, including esophagus, stomach, and either the duodenum and/or jejunum as appropriate, with delivery of thermal energy to the muscle of the lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease).

  • Code 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) is a component of 0061T (Destruction/reduction of malignant breast tumor including breast carcinoma cells in the margins, microwave phased array thermotherapy, disposable catheter with combined temperature monitoring probe and microwave sensor, externally applied microwave energy, including interstitial placement of sensor).
     
    Get the latest NCCI edits on CMS' Web site at http://www.cms.hhs.gov/physicians/cciedits/default.asp.

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