Anesthesia Coding Alert

You'll need to be aware of the G code bundles the next time your anesthesiologist deals with central venous access devices. NCCI 11.2 lists all three of these G codes as components of codes for these central venous access procedures:

"CPT states that vascular injection procedures include the necessary local anesthesia, introduction of needles or catheter, injection of contrast, and/or any necessary pre- and postinjection care," says Cindy Smith, CPC, of Professional Healthcare Billing Services in Charleston, W.V.

Remembering this - as well as the guidelines for reporting the highest-base procedure during a session - should help you submit claims that account for these edits.
 
"The physician inserts the line for a reason," Smith adds. "He uses it for monitoring or for access for fluids, whether with single or multiple drugs, whether IV push or drip. The line insertion is the most extensive procedure and should be what is billed."
 
'Most Extensive' Codes Also Include Epidurals, Blood Patches

The latest round of edits also bundles G0351 into the four epidural injection codes:

This bundle should not have too much effect on your coding, regardless of how often your physicians administer epidurals, Smith says, because the epidurals already include the injection represented by G0351.

The final pairs of interest to anesthesia practitioners involve epidural blood patches (62273, Injection, epidural, of blood or clot patch). The edits state that 62273 includes the three G codes.

Don't Take Indicator '1' for Granted

NCCI 11.2 assigns a status indicator of "1" to all pairs of edits covered above. Because of this, you can separately report the codes under certain circumstances using modifier 59 (Distinct procedural service). This might apply to situations involving cardiac or respiratory arrest, hypotension or atrial fibrillation/tachycardia.

However, special rules apply when you unbundle procedure codes that edits pair. Be sure you have the correct supporting documentation before reporting services this way, Smith says.

Coding key: Do not report these G codes with procedures for which IV push or infusion is an inherent part of the primary procedure, such as administration of contrast material for a diagnostic imaging study. "If a G code is an inherent part of a procedure, it is not separately reimbursable," says Scott Groudine, MD, an anesthesiologist in Albany, N.Y.

NCCI 11.2 went into effect July 1. To see a complete list of edits, log on to CMS' Web site at www.cms.hhs.gov/physicians/cciedits/default.asp.
 
Note: From a pain management perspective, the latest edits affect tendon and trigger point injections, arthrocentesis, percutaneous lysis of adhesions, neurolytic injections, nerve blocks, and neurolytic destruction. For more details, watch for the next issue of Anesthesia & Pain Management Coding Alert in September.