Anesthesia Coding Alert

NCCI Edit Update:

Be Careful: The Rules for Reporting Injections Have Changed

Published on Sun Aug 21, 2005

These common pain management procedures now include 3 popular G codes

The National Correct Coding Initiative (NCCI), version 11.2, edits effective July 1 included several changes that hit close to home for pain management groups: Trigger point injections and nerve blocks are just a few of the affected procedures that will change the way you report claims on a daily basis.

Check G Codes Against Tendon, TPI Procedures

Earlier editions of NCCI paired three G codes with hundreds of surgical procedures. It is important that you take a look at the descriptors for those G codes again because they have taken center stage again and now involve tendon and trigger point injection and arthrocentesis. The G codes are:

G0351 - Therapeutic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

G0353 - Intravenous push, single or initial substance/drug

G0354 - Each additional sequential intravenous push (list separately in addition to code for primary procedure).

According to NCCI, the following listed codes include G0353 and G0354 when performed during the same session:

20550 - Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia")

20551 - ... single tendon origin/insertion

20552 - ... single or multiple trigger point(s), one or two muscle(s)

20553 - ... single or multiple trigger point(s), three or more muscle(s)

20600 - Arthrocentesis, aspiration and/or injection; small joint or bursa (e.g., fingers, toes)

20605 - ... intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)

20610 - ... major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa).

At first glance it seems like bundling the G codes with these injection procedures might signal many changes, but that's not necessarily the case for anesthesia or pain management groups.

"The G codes do not apply to a trigger point injection or to nerve blocks. I've seen very few occasions when a G code would be reported for pain charges," says Joanne Mehmert, CPC, president of the consulting firm Mehmert and Associates in Kansas City, Mo.

"As far back as I can remember, we've never reported these codes together," adds Sherry Coughlin, billing manager with West Florida Anesthesia and Pain Management in Spring Hill. "These edits should not be anything new to billers or coders if they've been following NCCI for the last few years."

Also in the latest version of NCCI, G0351, G0353 and G0354 have been bundled into, and are considered components of, the following percutaneous lysis of adhesions codes:

62263 - Percutaneous lysis of epidural adhesions using solution injection (e.g., hypertonic saline, enzyme) or mechanical means (e.g., catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 2 or more days

62264 - ... 1 day.

Avoid Reporting G Codes with Neurolytic Injections, Nerve Blocks

The biggest pain management area covered by these edits concerns neurolytic injections, nerve blocks and destructions.

NCCI 11.2 lists all three of the G codes in question as components of the more comprehensive injections:

Neurolytic injection procedures 62280-62282 (different injection locations for Injection/infusion of neurolytic substance [eg, alcohol, phenol, iced saline solutions], with or without other therapeutic substance)

Neurolytic destruction procedures 64600-64681 (various types of injections and locations for somatic or sympathetic nerve destruction by a neurolytic agent [chemical, thermal, electrical or radiofrequency])

Neuroplasty procedures 64702-64726 (neuroplasty exploration, neurolysis or nerve decompression of nerves).

Coders who keep abreast of NCCI edits shouldn't be surprised by these changes, predicts Coughlin. "I frequently check for edits and changes to ensure a clean claims process," she explains. Coughlin's office often reports codes 64612-64640 for Botox injections so she makes sure she stays up to date with any new edits or changes to the rules for reporting these codes.

The edits also single out nerve block codes 64400-64530 (specific locations for diagnostic or therapeutic nerve blocks [introduction/injection of an anesthetic agent] to somatic or sympathetic nerves) as comprehensive procedures. But be sure to notice these codes only include G0351 for the therapeutic or diagnostic injection; NCCI 11.2 does not list codes G0353 and G0354 as components of the nerve blocks.

"The code descriptors for the pain injections and nerve blocks read 'injection,'" Mehmert points out. "It would be double billing to report the G code and the injection code for the same injection."

The bottom line: All coders and billers should to use the tools available in the CPT book, CCI reports and related Web sites, Coughlin notes.