Anesthesia Coding Alert

Get a head start on requesting reimbursement

Unlisted procedure codes can get complicated when it comes to pain management procedures. But with the right tools, you can come through with flying colors. Take a look at how you can make unlisted codes work for you.

According to the CPT 2008 Introduction under Instructions for Use of the CPT code book, you must not use codes that only approximate the service provided. When there is no specific code for the procedure or service, you should use an unlisted code.

Try 22899 or 64999 for Spinal Hardware Injection

"I get a lot of calls about spinal hardware injection," says Joanne Mehmert, CPC, CCS-P, in Kansas City, Mo., who recently hosted an audioconference on the subject of unlisted pain management codes.

A hardware injection is performed by injecting lidocaine along side spinal pedicle screws that were placed in the vertebrae during surgery. If patients continue experiencing pain after spinal fusion with hardware placement, sometimes the spinal surgeon will ask your pain management specialist to inject an anesthetic as a diagnostic injection to determine if the hardware is the source of the patient's pain. Due to the increased risk of infection, blood loss and spinal instability associated with the removal of the spinal hardware, spine surgeons want to verify that the second major surgery will relieve the patient's pain.

"There is no code for [hardware injection]," Mehmert says. "They are not doing an epidural and they're not doing a nerve block. So, it's simply diagnostic injection of an anesthetic." She recommends 22899 (Unlisted procedure, spine) or 64999 (Unlisted procedure, nervous system), both of which are unlisted.

Get Payer's OK for Pulse Radiofrequency

Pulse radiofrequency uses radio waves to intermittently affect the painful nerve, though it is not considered a destructive nerve procedure. For example, during a pulsed radiofrequency neurotomy, a small electrode is threaded through the needle. A pulsed electrical current is delivered through the tip of the electrode to the targeted nerve. This "stuns" the nerve, temporarily blocking its ability to transmit pain signals. For pulse radiofrequency of any anatomic region, on any nerve, use 64999, according to the AMA's CPT Assistant (August 2005.)

"There are some private or third-party payers that may not want to deal with the unlisted code," Mehmert cautions. "You could write to your private payer and try to get their blessing on using the 646.XX (Other complications of pregnancy, not elsewhere classified) codes. However, I would not recommend that unless you get that in writing. Go with the AMA guidelines."

Use Modifier 22 for Discography with FAD

A Functional Anesthetic Discography (FAD) procedure is similar to a discogram. The patient is given a mild sedative, and then a small catheter is inserted into each disc. The patient performs an activity to recreate the back pain, and anesthetic is injected at one disc at a time. This diagnostic study helps to determine which disc, if any, is causing the patient's back pain.

If your pain specialist performs a regular discography procedure on a disc and then in addition follows with the FAD procedure, you may consider using 62290 (Injection procedure for discography, each level; lumbar) and indicate the added FAD work by appending modifier 22 (Increased procedural services). In order to use modifier 22, the pain management provider's documentation should clearly support the substantial additional work and the medial necessity for the additional FAD procedure. If, however, the physician performs only the FAD without a standard discography, it would not be compliant to report 62290. The FAD procedure would be reported with the unlisted code 64999.

Don't Append Modifiers to Unlisted Codes

It is not appropriate to append modifiers to unlisted procedure codes, since the unlisted procedure codes do not describe specific procedures. A modifier is used to indicate that a performed service or procedure identified by a specific CPT code has been altered by some circumstance, but not changed in its definition. It can also be used to provide additional information to a payer about a particular procedure, Mehmert points out. "There's nothing about an unlisted code that you can tell a payer because it did not have a description to begin with," she says. CPT Assistant (April 2001) added support to this issue by stating that since unlisted codes do not include descriptor language that specifies the components of a particular service, there is no need to "alter" the meaning of the code.

Resource: If you need help with unlisted codes and would like to purchase a transcript or copy of the audioconference "Take the Unknown Out of Coding Unlisted Pain Management Procedures" please email contact@audioeducator.com.