Anesthesia Coding Alert

The latest version of the National Correct Coding Initiative edits bundles guidance for needle placement into two procedures commonly encountered by anesthesiologists. Check out these bundles and others, effective Sept. 1 through Dec. 31, and apply them to your daily coding.

Watch Fluoroscopic Guidance Coding

 Anesthesiologists often use fluoroscopic guidance for needle placement during various procedures. Several codes relate to fluoroscopy, but the two that anesthesiologists use most often are 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) 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).
 
Previous NCCI edits already bundle fluoroscopic guidance with some procedures. According to these latest edits, 76005 is now a component of 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) and 63685 (Incision and subcutaneous placement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling).

Add Another Injection Code and CPAPs to Bundled Lists

Injection code CPT 64425* (Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves) is now a component of several surgical codes. These include most codes related to initial inguinal hernia (reducible or incarcerated or strangulated) repair (49491, 49492, 49495, 49496, 49500, 49501 and 49507) as well as repair of recurrent inguinal hernias or sliding hernias (49520, 49521 and 49525) and initial or recurrent femoral hernia (49550, 49553, 49555 and 49557).
 
Fortunately from a reimbursement perspective, the anesthesiologist would report the appropriate anesthesia code for the hernia procedure under MAC (monitored anesthesia care) instead of the single injection, so the bundling won't affect the bottom line or how you code the case.
 
Now CPAP code 94660 (Continuous positive airway pressure ventilation [CPAP], initiation and management) and CNP code 94662 (Continuous negative pressure ventilation [CNP], initiation and management) are components of codes 99217 (Observation care discharge day management), 99218-99220 (Initial observation care, per day ...), and emergency department service codes 99281-99285. Again, these edits are good to note but won't come into play very often since the services are always part of a more global procedure such as ventilator management (00540, Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum [including surgical thoracoscopy]; not otherwise specified, or 00541, ... utilizing one lung ventilation).
 
If the lists of NCCI edits have your head spinning each quarter, now there's a way you can keep up with the latest NCCI edits for free. CMS recently started posting NCCI edits on its Web site. The edits are grouped by specialty, so it's easy to find the ones that apply to your practice. And you can keep track of all edits to a particular code because the lists are cumulative.
 
Log on to http://www.cms.hhs.gov/physicians/cciedits/ default.asp for the latest edit information. The site also includes the Medicare Physician Fee Schedule at  http://www.cms.hhs.gov/physicians/default.asp.