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Anesthesia Coding Alert

NCCI 10.2 Update:

Anesthesia, Pain Management Edits Are Easy to Incorporate

Published on Wed Jul 07, 2004

Check for changes affecting injection, hernia, TIPS coding

Version 10.2 of the National Correct Coding Initiative (NCCI) edits, which went into effect July 6, might change the way you code anesthesia during certain procedures or some common pain management injections and medications, but the changes don't come as a big surprise to some coders.

Watch Hernia, TIPS Coding With Mutually Exclusive Edits

The list of mutually exclusive edits includes several anesthesia and other procedure codes of interest to anesthesiologists. "Mutually exclusive" edits apply to procedures that CMS states that the physician cannot reasonably perform during the same patient encounter.

NCCI 10.2's mutually exclusive edits pair three anesthesia codes with other anesthesia procedures:

  • You cannot bill 00830 (Anesthesia for hernia repairs in lower abdomen; not otherwise specified) or 00832 (... ventral and incisional hernias) with 00834 (Anesthesia for hernia repairs in the lower abdomen not otherwise specified, under 1 year of age) or 00836 (Anesthesia for hernia repairs in the lower abdomen not otherwise specified, infants less than 37 weeks gestational age at birth and less than 50 weeks gestational age at time of surgery).
  • You cannot bill 01991 (Anesthesia for diagnostic or therapeutic nerve blocks and injections [when block or injection is performed by a different provider]; other than the prone position) with 01992 (... prone position).

    Anesthesiologists certified to perform TIPS procedures can no longer bill the two procedure codes during the same session. NCCI 10.2 officially lists 37182 (Insertion of transvenous intrahepatic portosystemic shunt[s] [TIPS] [includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract formation/dilatation, stent placement and all associated imaging guidance and documentation]) and 37183 (Revision of transvenous intrahepatic portosystemic shunt[s] [TIPS] [includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recanulization/dilatation, stent placement and all associated imaging guidance and documentation]) as mutually exclusive.

    "If the TIPS procedure wasn't successful and the physician revised it the same day or within the global period, it may be plausible to bill both these codes," says Kelly Dennis, CPC, owner of Perfect Office Solutions in Leesburg, Fla. "The edits classify 37182 and 37183 with a '1,'which means you can report the codes with a modifier to differentiate the services and be paid for both."

    Nonmutually Exclusive Edits Hit Injections Again

    Nonmutually exclusive edits pair codes for services that are included as part of more global (or comprehensive) procedures.

    Several edits in NCCI 10.2 will interest anesthesiologists and pain management specialists, especially those affecting common injection procedures.

    The edits include J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg) as a component of tendon and trigger point injection procedures:

  • 20550 -- Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia")
  • 20551 -- ... single tendon origin/insertion
  • 20552 -- Injection(s); single or multiple trigger point(s), one or two muscle(s)
  • 20553 -- ... single or multiple trigger point(s), three or more muscles.

    The edits also bundle J2001 with diagnostic or therapeutic blocks to somatic and sympathetic nerves (codes 64400-64530) and with many somatic nerve destruction codes (from neurolytic destruction codes 64600-64640).

    NCCI 10.2 designates that codes J2001 and 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction) are bundled with 64680 (Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus). The edits also list 76005 as a component of 64681 (... superior hypogastric plexus).

    The final edit of interest to pain management specialists involves two sciatic nerve injection codes. NCCI 10.2 bundles 64446 (Injection, anesthetic agent; sciatic nerve, continuous infusion by catheter [including catheter placement] including daily management for  anesthetic agent administration) into comprehensive code 64712 (Neuroplasty, major peripheral nerve, arm or leg; sciatic nerve).

    "When you report anesthesia services, you should only submit the anesthesia code with the highest base units when the physician performs multiple services, unless add-on codes apply to the scenario," says Samantha S. Mullins, CPC, manager of coding and compliance with Vital Med Inc., in Birmingham, Ala. "Because of this, the NCCI changes are 'common sense' edits that you should have been doing prior to their implementation."

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