Anesthesia Coding Alert

CPT introduces new codes and returns to 01996 Memorizing all of CPT's anesthesia codes doesn't mean you have all of your coding bases covered. CPT 2004 includes new codes that increase injection specificity and reflect new fluoroscopic and ultrasonic guidance techniques. Specify Injection Approach With 64449 The new CPT book includes three new injection codes - found outside the anesthesia section - that will improve coding specificity for some pain management procedures:
 
64449 (Injection, anesthetic agent; lumbar plexus, posterior approach ...). Report this new member of the somatic injection family of codes in place of 64450 (... other peripheral nerve or branch) when appropriate. Physicians would never use an anterior approach for this injection, but stating "posterior approach" makes the code more specific.
 
The technique represented by 64449 can provide pain relief similar to an epidural and might be associated with less risk for some patients. More physicians are administering these injections for acute post-op pain management, especially following lower- extremity joint replacement. 64449 is a 12-unit code with a 10-day global period.
 
64517 (Injection, anesthetic agent; superior hypogastric plexus). Physicians primarily use superior hypogastric plexus blocks to manage pelvic pain, usually cervical, testis, endometrial or colorectal pain. Some physicians use these blocks to treat radiotherapy-induced proctitis, and it may prove beneficial for diagnosing and managing chronic pelvic pain conditions. 64517 is a 10-unit block code.
 
64681 (Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus). You'll appreciate having the two new codes for superior hypogastric plexus injections in CPT 2004 because physicians are administering these injections more frequently, says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C. The biggest difference between this code and 64517 is that 64681 represents permanent nerve destruction (that is, the physician injects alcohol instead of a local anesthetic for the block). 64681 is a 20-unit code. Add 2 Codes to Your List of Anesthesia-Related Guidance Codes CPT 2004 includes two new fluoroscopic and ultrasonic guidance codes that allow you to report some services more accurately:
 
+75998 (Fluoroscopic guidance for central venous access device placement, replacement [catheter only or complete], or removal [includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter placement] [list separately in addition to code for primary procedure]). This code covers a lot of territory, so here are the main points: The physician uses fluoroscopy to place, replace or remove a device. You cannot charge separately for the contrast injection (the hospital will probably charge for the drug itself), and the code includes all radiology supervision and interpretation related to any part of the [...]