Anesthesia Coding Alert

The descriptors for these codes specify "without anesthesia." Procedures qualifying for these services aren't extensive enough to need anesthesia, says Scott Groudine, MD, an Albany, N.Y., anesthesiologist. If anesthesia services are necessary for the debridement, the surgeon should report more extensive codes than 97597 or 97598.
 
Note: New codes 97597 and 97598 replace 97601 (Removal of devitalized tissue from wound[s]; selective debridement, without anesthesia [e.g., high-pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session), which CPT 2005 deleted.
 
The edits involving 97597 and 97598 include too many anesthesia codes to list individually (the edits encompass all but 23 of the anesthesia codes). The exempted codes include extensive procedures such as transplantation, cardiac and some deep internal procedures that require anesthesia, says Barbara Johnson, CPC, MPC, an anesthesia coding consultant and president of Real Code Inc., in San Moreno, Calif.
 
Tip: You should still check the complete list of edits to verify whether they apply to the case you're coding before you submit your claim.
 
NCCI assigns a status indicator of "0" to these pairs, which means you cannot use a modifier to report the services separately. The single exception is 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration), which has a status indicator of "1" when paired with 97597 or 97598. This means you can report both services (01996 and either 97597 or 97598) with modifier -59 (Distinct procedural service) to differentiate the procedures and receive payment for both. Special rules apply when you unbundle codes that the edits pair, so be sure you have the correct documentation before reporting services this way.
 
"Code 01996 probably is excepted from these edits because it is a pain management code," Johnson says. "Because of this, it would be a separate service from removal of devitalized tissue (which is very superficial  in nature)."
 
Groudine agrees. "The debridements do not require anesthesia, but pain therapy may be necessary," he says. "If the patient had a trauma to the lower extremity that required pain management but did not require anesthesia for the debridement, you could report 01996 for the pain management."

Anesthesia Included in 30+ Other New Codes

NCCI 11.0 also includes approximately 40 edits based on the premise that the surgical procedure already includes anesthesia service. Again, each edit designates a new CPT code as the comprehensive procedure. Some of these pairings include:

Edits Even Affect New Category III Codes

The new edition of NCCI includes bundles of anesthesia services with several new Category III codes. Category III codes are temporary codes that allow carriers to track data for the particular service or procedure. Most of the Category III edits apply to 01926 (Anesthesia for therapeutic interventional radiologic procedures involving the arterial system; intracranial, intracardiac, or aortic), which NCCI bundles into:

"These changes look reasonable, as all endovascular grafts involve interventional radiology," Groudine says. "If you bill for the graft procedure, then 01926 is part of the procedure."
 
Check the CMS Web site http://www.cms.hhs.gov/physicians/cciedits/default.asp for a complete look at NCCI version 11.0 edits.