Anesthesia Coding Alert

When the Correct Coding Initiative (CCI) edits (7.2) took effect in July, codes related to anesthesia services were not greatly affected, but pain management codes were.
 
"Many codes used by interventional pain management physicians are now bundled into comprehensive codes," says Patricia Bukauskas, CMM, CPC, a pain management coding and reimbursement specialist in Aliquippa, Pa. "There are also several other general changes to be aware of."
 
With so many revisions to component and mutually exclusive codes, Bukauskas advises coders to watch these areas closely. Component codes are included in services designated by broader-scope comprehensive codes; mutually exclusive codes are for services that cannot be performed in the same session.
 
Note: An update on changes to mutually exclusive codes will be in the October issue of Anesthesia and Pain Management Coding Alert.

General Changes for Epidurals and Injections

 
Some codes for nerve blocks or other injections can no longer be used with fluoroscopy codes 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034), 76001 (fluoroscopy, physician time more than one hour, assisting a non-radiologic physician), 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). "This is one area where pain management specialists have been able to bill an additional code for services and increase their reimbursement," says Barbara Johnson, CPC, MCP, professional coder with the physician group Loma Linda University Anesthesiology Medical Group Inc. in Loma Linda, Calif. "This new exclusion will decrease reimbursement greatly." 
 
Epidural procedures performed in the same region cannot be combined, including lysis, interlaminar, caudal and transforaminal epidurals. Although physicians at Loma Linda do not commonly administer multiple epidurals in the same area, Johnson says physicians at other facilities who may have done it before will no longer be able to.
 
Nerve blocks and neurolytic blocks performed in the same region cannot be combined. For example, if a physician administers local anesthesia through a needle as a test and achieves pain relief for the patient, he or she might then inject alcohol or another neurolytic agent. Rather than billing a local and neurolytic block, only the neurolytic block should be billed, and will be paid as a comprehensive procedure.
 
Epidurals can no longer be billed with diskograms. Diskography, 62290* (injection procedure for diskography, each level; lumbar), now includes injection codes 62311, 62319, 64479 and 64483. Three of these four bundled codes -- 62311, 62319 and 64483 -- are also components of chemonucleolysis, 62292 (injection procedure for chemonucleolysis, including diskography, intervertebral disk, single or multiple levels, lumbar). Trigger point injections and joint injections cannot be combined with many somatic nerve blocks and transforaminal epidurals. These include 64400-64483, which refer to different types of blocks to the somatic nerves.

Comprehensive-Code Changes

 
The changes to comprehensive codes apply to services performed for a new or established patient in an office, outpatient or hospital setting, as well as inpatient consultations and emergency services.
 
Comprehensive codes make it easier to bill because providers bill only one code for multiple procedures, instead of several. However, billing for multiple procedures usually results in more payment, so comprehensive codes make billing easier but lower the bottom line. A good example of this is a short anesthetic, which includes intubation, IV starting, pulse oximetry monitoring, end tidal carbon dioxide monitoring and pre- and postoperative visits. If these services are billed individually, they are likely to add up to more than most short anesthetics cost.
 
Your practice might see the following bundled codes most often. Check CCI 7.2 for a complete list.
 
Note: Copies can be obtained from the National Technical Information Service [NTIS, the authorized distributor for CMS] by calling 800-363-2068. You can also call this number to subscribe to quarterly updates.

 

Percutaneous vertebroplasty (22520): When the new codes 22520, 22521 and 22522 for percutaneous vertebroplasty were introduced in CPT 2001, coding for the procedure seemed much easier than in the past. But now related codes 36005, 72128, 72129, 72130, 75872, 76000 and 76005 (which are for injections, radiology or fluoroscopy associated with the vertebroplasty procedure) have been bundled into the primary codes 22520 or 22521. Code 22522 (percutaneous vertebroplasty; each additional thoracic or lumbar vertebral body) should still be used to report treatment of additional vertebrae.

 

Arthrodesis comprehensive codes (22548-22612): Codes 62310, 62318 and 64479 have been bundled into this group. The newly included codes all document epidurals or injections for pain management.

 

Sacroiliac joint arthrography (27096): Injection codes 20600, 20605 and 20610 are components of the arthrography procedure. Other codes noted as components of the procedure include 69990 for the operating microscope, 76000-76005 for fluoroscopy, and 90782 for administering the therapeutic substance.

 

Percutaneous lysis of adhesions (62263): Many codes are bundled with this procedure. They include 62281, 62282, 62284, 62310, 62311, 62318, 62319, 64479, 64483 and 64722. Fluoroscopy codes 76000, 76003 and 76005 are also included with lysis of adhesions. "Lysis of adhesions is included in abdominal surgery and probably should be included in back surgery," Johnson notes. "Bundling all of these codes with lysis of adhesions probably means that authorities believe that reporting of the services is being abused and should be included as part of the surgery."

 

Diagnostic and therapeutic spinal punctures (62270 and 62272): Injection codes 62273, 62311 and 64483 are components of both types of puncture procedures. Puncture and injection codes 62270, 62310 and 64479 are also bundled with therapeutic spinal puncture used for drainage of spinal fluid (62272). Fluoroscopy codes 76000-76003 are also included with both spinal puncture procedures. 

 

Epidural blood patch (62273): Blood patches are often used to treat headaches following spinal injections. Codes used to report introduction of the needle or intracatheter for the procedure (36000, 36140 and 36410) as well as injection codes (62310, 62311, 64479 and 64483) and others are now included with the primary procedure. 
 

Neurolytic substance injections with or without other substances (62280 and 62281): Catheter placement and epidural injection codes 62284, 62310, 62311, 62318, 62319, 64479 and 64483 have been bundled with neurolytic injections. Spinal puncture codes 62270 and 62272 are also components of neurolytic code 62280. While several codes have been bundled with 62273 for epidural blood patches, this comprehensive code is now a component of the neurolytic injections. And again, fluoroscopy codes 76000-76003 are bundled with this new comprehensive group.
 
 
"In many cases it's easy to see why codes are bundled," Johnson says. "For example, in some cases the use of fluoroscopy is standard care, so it would be impossible to do the procedure without using some of the disallowed codes like fluoroscopy and venipuncture. The biggest challenge with keeping up-to-date with CCI edits is being able to read and assimilate all the information."
 
Note: See the article at http://codinginstitute.com/docs  Document 25 for information on how to read and interpret the changes.