Anesthesia Coding Alert

New procedures and techniques are constantly being added to the field of medicine. And although patients and providers often welcome these advances, finding a code that represents adequate reimbursement for the provider and is accepted by the carrier may be another story. One such example is spinal endoscopy, a procedure that does not have a CPT code assigned to it. Anesthesia providers should be able to receive adequate reimbursement by choosing from several coding options, establishing medical necessity and working with local carriers to file with their preferred codes.


Coding Spinal Endoscopies


Some anesthesia providers are just beginning to get involved with spinal endoscopies and are still searching for the most appropriate codes for proper reimbursement. Consider using these codes and modifiers, but check with your local carrier for its preference:

CPT 62263 percutaneous lysis of epidural adhesions using solution injection (e.g., hypertonic saline, enzyme) or mechanical means (e.g., spring-wound catheter) including radiologic localization (includes contrast when administered). This code includes fluoroscopic guidance and epidural injection components.

Modifier -22 unusual procedural services. We plan to use this modifier with claims because this is a much more difficult procedure than the RACZ catheter procedure, says Jann Lienhard, CPC, of the physician group Bergen Pain Management in Paramus, N.J. (The RACZ, or epidurolysis, procedure is used to dissolve some of the scar tissue from around entrapped nerves in the epidural space of the spine, so medications such as cortisone can reach the affected area.) The modifier would be used in addition to a primary code such as 62263.

CPT 72275 epidurography, radiological supervision and interpretation. This code may be considered for interpretation of the procedure when the provider dictates a formal radiological supervision and interpretation report and makes it part of the patients record. Carriers may allow this code to be used in addition to code 62263.

Modifier -26 professional component. Use this modifier as applicable in conjunction with 72275 if someone other than the performing physician owns the equipment.

64999 unlisted procedure, nervous system. Some carriers prefer this code for reporting spinal endoscopy for the percutaneous lysis of epidural adhesions.

01999 unlisted anesthesia procedure. We dont like using this one because its always better to be more specific with coding, but sometimes this is the only code carriers will accept for a procedure, says Lewis Woodell, director of reimbursement and compliance in the anesthesia billing office of Summit Healthcare in Fort Worth, Texas.

Lienhard adds that her group also will be billing for myelography (72240-72270) and/or fluoroscopy (76005) when appropriate.

How do you find out which codes work for others in your area? Networking is the key for Lienhard. I talk with other coders as often as possible to learn what codes theyre using in certain situations and what has worked for them, she says.

But just because particular codes work in one state doesnt mean they will work in others. For example, Joni Hyrick, executive vice president and COO of Pain Centers of America Inc., which owns two ambulatory surgery centers (ASC), and is based in Buffalo, N.Y., says that they are more successful billing in some areas than in others. We are successful billing it [spinal endoscopy] thus far in New York state, mainly due to the doctors efforts, she says. But were not so successful billing it in Colorado.

Become familiar with the codes that the carriers in your area will accept for the procedure.


Establish Medical Necessity


One key to achieving reimbursement for spinal endoscopy is obtaining precertification, according to Lienhard. Many carriers dont understand the procedure or the length of time it takes, so they pay minimal amounts for it, she says. Ive been getting mixed information on the billing amount for the procedure, so Im also trying to get something in writing from the commercial carriers in regard to setting a proper fee schedule.

The precertification process establishes medical necessity from the carriers point of view. A number of ICD-9 codes may be accepted as diagnoses indicating medical necessity for the procedure. The following diagnosis codes may be appropriate for spinal endoscopy, but check with your local carrier for verification:

722.83 postlaminectomy syndrome, lumbar region
724.4 thoracic or lumbosacral neuritis or radiculitis, unspecified
724.9 other unspecified back disorder; compression of spinal nerve root NEC
729.2 neuralgia, neuritis and radiculitis, unspecified
953.2 injury to nerve roots and spinal plexus, lumbar root
953.3 injury to nerve roots and spinal plexus, sacral root
953.5 injury to nerve roots and spinal plexus, lumbosacral plexus

By the same token, certain carriers may not accept other diagnosis codes. For example, Medicare will not cover 724.2 (lumbago, lumbalgia, low back pain, low back syndrome) as a diagnosis supporting medical necessity for spinal endoscopy.

Woodell adds that documentation plays a key role in reimbursement, as with many procedures. Automatically send a copy of the operative report and a hard copy of the epidural radiograph to help document the case for the carrier.

We have the doctor describe the procedure and send that information along with the claim, Woodell says. Even so, we end up appealing about 35 percent of the cases because theyre denied. But we keep working with the carriers and eventually get all or most of the cases paid.