Anesthesia Coding Alert

Tip:  Watch pairings with new hydration codes.

If you code for pain management services, watch for NCCI 12.0's edits related to some of your most common procedures--including many related to the new kyphoplasty codes.

NCCI lists kyphoplasty procedures 22523 (Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, one vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty]; thoracic) and 22524 (- lumbar) as the comprehensive, or greater, service with many edit pairs. Kyphoplasty now includes procedures such as:

- epidural injections (62318-62319)
- nerve blocks (64415-64417)
- fluoroscopy and fluoroscopic guidance (76000-76005)
- evoked potential and reflex tests (95925-95937).

Kyphoplasty and vertebroplasty procedures 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) and 22521 (- lumbar) are also the comprehensive components of edits involving five new hydration, therapeutic, prophylactic and diagnostic injection codes (90760, 90765, 90772, 90774 and 90775).
 
NCCI 12.0 also considers the new hydration codes and new HCPCS codes C8950 (Intravenous infusion for therapy/diagnosis, up to 1 hour) and C8952 (Therapeutic, prophylactic or diagnostic injection, IV push) to be components of many pain management injection procedures. Comprehensive services in these pairs include:

- trigger point injections (20552-20553)
- arthrocentesis, aspiration and/or injections (20600-20610)
- aspiration and/or injection of ganglion cyst (20612)
- insertion of central venous access device (36555-36571)
- arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure) (36620-36625)
- somatic or sympathetic nerve injections (64400-64530)
- somatic and sympathetic nerve destruction with neurolytic agent (64600-64680)
- neuroplasty and decompression procedures (64702-64726)
- epidural injection procedures (single-shot injection or continuous infusion) (62310-62319)
- Swan-Ganz catheter placement (93503).

Will these edits affect your pain management coding? They really shouldn-t, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y.
 
-If a person is dehydrated, the physician usually must correct it before doing a pain procedure,- he says. -If you hydrate someone to make it easier to place a central line, then that hydration is part of the line placement.-