Anesthesia Coding Alert

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 [...]