Anesthesia Coding Alert

Good news:  There are exceptions that NCCI doesn't touch

If you routinely code for central venous catheter placements, be sure you don't code the placement in addition to the procedure's anesthesia, because CVCs make up one of the biggest categories affected by NCCI version 12.1 edits, effective April 1.

Nonmutually exclusive edits pair services that normally go together. One code is considered the comprehensive code, which means it encompasses the other code of the pair (called the component code).

Anesthesia is comprehensive: The latest round of nonmutually exclusive edits lists all anesthesia procedures as the comprehensive components of edit pairs involving almost all CVC procedures (36555-36590). Exceptions to the edits--meaning you can still code separately for the catheter procedure and anesthesia--include:

• 36556--Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older

• 36569--Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age 5 years or older
 
• 36575--Repair of tunneled or non-tunneled central venous access catheter, without subcutaneous port or pump, central or peripheral insertion site

• 36580--Replacement, complete, of a non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access

• 36584--Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access

• 36589--Removal of tunneled central venous catheter, without subcutaneous port or pump.

Anesthesia, TEE Services Include Moderate Sedation

The descriptors for CPT's new moderate sedation codes 99143 and 99144 state that you shouldn't use them with anesthesia codes:

• 99143--Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; under 5 years of age, first 30 minutes intra-service time

• 99144--... age 5 years or older, first 30 minutes intra-service time.

NCCI 12.1 takes this mind-set a step further by officially listing the moderate sedation codes as components of all anesthesia codes.

TEE checkpoint: The same holds true for TEE (transesophageal echocardiography) procedures: The TEE procedure includes moderate sedation. Codes affected by this edit include:

• 93312--Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report

• 93313--... placement of transesophageal probe only

• 93314--... image acquisition, interpretation and report only

• 93315--Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report

• 93316--... placement of transesophageal probe only 

• 93317--... image acquisition, interpretation and report only

• 93318--Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis.

"This edit is common sense," says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. "If the anesthesiologist is billing for anesthesia during the procedure, the surgeon should not also bill for sedation."
 
Tables Turn With Debridement Coding    

A few other edits place anesthesia codes in the other column of comprehensive and component code pairs.

Component check: NCCI lists all anesthesia codes as components of wound care codes 97602 (Removal of devitalized tissue from wound[s], non-selective debridement, without anesthesia [e.g., wet-to-moist dressings, enzymatic, abrasion], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session), 97605 (Negative pressure wound therapy [e.g., vacuum-assisted drainage collection], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session; total wound[s] surface area less than or equal to 50 square centimeters), and  97606 (... total wound[s] surface area greater than 50 square centimeters).

Watch 01995: In the final edits involving anesthesia codes, NCCI lists 01995 (Regional intravenous administration of local anesthetic agent or other medication [upper or lower extremity]) as a component of moderate sedation codes 99143-99149.
 
Although this edit involves anesthesia code 01995, Groudine doesn't expect the ruling to really affect anesthesia providers.
 
"Code 01995 is more of a procedure code, and the anesthesiologist would report an anesthesia code instead," he says. "A surgeon might inject a local anesthetic in the vein of an extremity he's working on. This edit makes it clear that he can't bill separately for that."

For a full list of edits, visit the CMS Web site at www.cms.gov.