Anesthesia Coding Alert

Check these 3 areas to be sure you're up to speed If your physicians routinely provide short-term pain management services, don't shortchange your claims by reporting incorrectly. Verifying a few simple details can make a difference in the code you submit -- and your group's bottom line. Clue in to Terminology   Acute pain management treats short-term pain, often following the patient's surgery. Physicians can administer epidurals, spinals or blocks, depending on the situation. When you code your claims, watch for some key words in your provider's documentation -- they can help you code correctly and possibly bump up the base units you report.
 
Keep these terms in mind as you code:
 
• Continuous versus single: Sometimes your physician simply administers a single-shot injection to relieve the patient's pain; sometimes he needs to do more. Knowing the type of injection -- and having supporting documentation -- could mean a difference of four or five base units.
 
Example: Your physician administers an interscalene block following shoulder surgery. If he administers a single injection, report 64415 (Injection, anesthetic agent; brachial plexus, single) at eight base units. If he inserts a catheter for continuous infusion, however, report 64416 (... brachial plexus, continuous infusion by catheter including daily management for anesthetic agent administration) at 13 base units instead.
 
• Prone position: Surgical positioning makes a difference in reimbursement, Hal Nelson, CPC, vice president of anesthesia with CompONE Ltd. recently told attendees at the University of Chicago's Anesthesia Billing and Management Conference in Las Vegas.
 
If one of your physicians provides anesthesia while another physician administers a nerve block, be sure to check the patient's position. Code the anesthesia service with either 01991 (Anesthesia for diagnostic or therapeutic nerve blocks and injections; other than the prone position) or 01992 (... prone position).
 
Being able to report the prone position means five base units instead of three. Then code the second physician's pain management service accordingly, such as with the appropriate nerve block choice from 64400-64484 (Injection, anesthetic agent ...). Note: Physicians do not administer many of these nerve blocks while the patient is in the prone position, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. Watch for notes regarding prone position with sciatic nerve blocks (64445, ... sciatic nerve, single; and 64446, ... sciatic nerve, continuous infusion by catheter, [including catheter placement] including daily management for anesthetic agent administration), lumbar plexus blocks (64449, ... lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) and 64450 (... other peripheral nerve or branch).  Follow Medical Direction Guidelines      You need to be especially careful when coding services that your anesthesiologists report as medically directed. These guidelines -- known as the seven rules of medical direction -- [...]