Anesthesia Coding Alert

Although a new system of pain management codes has been in effect for more than a month now, anesthesia coders still are having problems adjusting to the new codes (see CPT 2000 Changes for Anesthesia Practices, Anesthesia Coding Alert, December 1999). According to L. Charles Novak, MD, an anesthesiologist in Wenatchee, Wash., and chair of the American Society of Anesthesiologists (ASA) committee on economics, and Stanley W. Stead, MD, professor and vice chair of anesthesiology at UCLA Healthcare and the ASAs representative to the CPT Advisory Panel, there are ways to cut through the confusion. Pairing the new codes with other procedure codes and the appropriate modifiers will gain reimbursement for anesthesiologists, they claim.

The changes are dramatic and affect every anesthesia group that provides pain management services, says Novak. Changes to the pain codes are described below. This information may be used as a general guide, but refer to CPT 2000 for complete descriptors of each code.

1. New Codes for Subarachnoid and Epidural Injections: The largest group of new pain codesthere are 16deals with administering subarachnoid and epidural injections. These are codes 62310-62319, codes 64470-64484, and codes 62263, 64626, 62627 and 27096. They fall under two procedure groups:

Spinal and epidural injections (not involving neurolytic substances) for both single-shot and continuous techniques. The generic descriptor includes needle and catheter placement, the injection of contrast material, and injection of any agent that is not neurolytic. More specific codes within the group divide services between single-shot and continuous treatment and distinguish between various levels of approach.

Percutaneous lysis of epidural adhesions (with or without endoscopic guidance) Code 62263 covers the use of hypertonic saline, enzyme or mechanical techniques for lysis.

Most of these codes are self-explanatory and stand on their own. However, codes 62318 and 62319 (which deal with injections with or without contrast of a diagnostic or therapeutic substance to either the cervical/thoracic or lumbar/sacral area) must be reported along with code 01996 to report daily management of epidural or subarachnoid drug administration.

Code 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]) requires epidural contrast injection for analysis of the epidural space prior to the injection of the neurolytic agent. Therefore, code 72275 (epidurography, radiological supervision and interpretation) also should be reported to describe the work involved.

2. New radiological codes: Three new radiological codes were added to CPT 2000. They are:

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)

72275 (epidurography, radiological supervision and interpretation)


73542 (radiological examination, sacroiliac joint
arthrography, radiological supervision and interpre-
tation).

These codes fall under one procedure group: facet injections and transformational approaches to the epidural space. The previous codes for facet injections have been greatly expanded (past editions of CPT included only two codes for facet injections, both of which referred only to the lumbar area of the spine). The new codes are unilateral and distinguish between single and additional levels of injection as well as different levels of approach.

Codes 72275 and 73542 must be billed with a formal radiological report. Stead also points out that there will be limits on coverage for these codes.

Injection of contrast medium during fluoroscopic guidance and localization is an inclusive component of codes 62270-62273, 62280-62282, 62310-62319, 64470-64484 and 64622-64627. Fluoroscopic guidance and localization is reported using code 76005 unless a formal contrast study (myelography, epidurogram or arthrography) is performed. In that case, the use of the fluoroscopy is included in the supervision and interpretation code. For example, myelography would be reported with codes 72240-72270, epidurography with code 72275, and sacroiliac joint arthrography with code 73542 (there are other arthrography codes for other major joints such as the shoulder, hip, etc.).

CPT 2000 has made codes 64470-64484 unilateral procedures. The old code for facet injection said single level but did not state whether the block was unilateral or bilateral. Novak says the lack of clarification created confusion, but the new descriptors clear up any questions for their uses. When any of these procedures are reported as being performed on both sides of the spine, add modifier -50 (bilateral procedure) to the code.

According to Medicares 2000 National Physician Fee Schedule Relative Value File, these codes are given an indicator of 0. That means no additional payment will be made, even if the procedure is filed with modifier -50 or -RT or -LT (right side or left side, respectively; used to identify procedures performed on that side of the body). Medicare no longer will pay for only one unit. The payment will be based on the lower of: (a) the total actual charge for both sides or (b) 100 percent of the fee schedule amount for a single code.

3. Deleted codes and their replacements: With the new codes now in effect, a number of old codes have been deleted. These codes fall into three groups:

Deleted codes for the administration of an anesthetic or narcotic: 62274-62279. Instead, use codes
62310, 62311, 62318 or 62319.

Deleted codes for administration of substance other
than anesthetic (steroid): 62288-62289, 62298. Use codes 62310 or 62311 in their place.

Deleted codes for administration of anesthetic
agents (nerve block): 64440-64443. Use 64475-
64484 in their place.