Anesthesia Coding Alert

Coding for somatic nerve injections will get even easier when CPT Codes 2003 goes into effect next month, thanks to several new and revised codes with more specific descriptors.

CPT has added four new somatic nerve injection codes and has revised two existing codes to coincide with the additions.

The CPT changes define whether the service is for a single injection or for a catheter insertion for continuous administration and daily management of an anesthetic. "Being able to differentiate between single and continuous administration will be advantageous for many providers," say coders such as Beverly M. Gillespie, CPC, billing and collection manager with PSG Billing and Collection in Milwaukee.

Cut Down on Using Unlisted-Procedure Codes

Some of the wording changes in the new and revised codes are so minor that you could easily miss them. But paying attention to the details will help you code correctly and will virtually eliminate use of the unlisted-procedure code for these injections. Keep an eye out for these changes:

 

64415* Injection, anesthetic agent; brachial plexus, single. This code (as well as several others in the injection group) has been revised to represent single injections.

64416* brachial plexus, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration. This new code balances the 64415 revision. You should use a continuous brachial plexus block for cases such as treating reflex sympathetic dystrophy (RSD) of the upper extremity or during extensive upper-extremity surgery. You will use all of the codes in this group that specify "continuous infusion" in an inpatient setting rather than as an outpatient service or treatment in the physician's office.

64445* ... sciatic nerve, single. Again, the designation of "single" is new.

64446* sciatic nerve, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration. This is another new code. Femoral and/or sciatic nerve blocks are becoming more common in joint replacement surgery (particularly the knee), says Albany, N.Y., anesthesiologist Scott Groudine, MD. "Many practices are switching from managing postoperative pain in these patients from an epidural to a continuous nerve block technique," he says.

64447* ... femoral nerve, single. This is another new code that distinguishes the treatment as a single injection.

64448* femoral nerve, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration. Groudine expects coders to use this new code for knee surgery or similar cases.

Many coders and pain management specialists are pleased to have specific codes for single injections rather than continuous infusion. They expect to make particularly good use of new codes 64445 and 64447.

For example, a patient may have continual leg pain that tests show does not originate from a pinched spinal cord nerve. The anesthesia provider may administer a femoral block to help decrease pain and inflammation.

"You can use a femoral block as a diagnostic tool to help you track down the source of the problem or as a therapeutic treatment if the patient's pain originates in the leg," says Robin Fuqua, CPIC, a coder for pain management specialist Jose Veliz, MD, in Escondido, Calif. "Sometimes if you administer a block and stop the pain signals, the pain may go away even after the block has ended. This can be especially true if the nerve seems to be signaling pain for no conclusive reason it's like turning off the pain alarm."

In the past, you would have coded situations such as this with 64450* (Injection, anesthetic agent; other peripheral nerve or branch). Beginning in January, you should code the same scenario as 64447.

In Fuqua's opinion, 64447 is "definitely" a code that will be used often. "I'm happy the new CPT has codes for specific injection sites," she says. "That makes reporting much more accurate and is much better than using general codes like 64450."

Continuous Infusion Codes Clarify Services

When studying the changes, you should note that the codes related to continuous infusion (64416, 64446, 64447 and 64448) include the catheter placement and all applicable daily management.

The old codes didn't clarify what to do if the anesthesia provider inserted a catheter and then repeatedly administered a local anesthetic. So the changes to this group of codes help describe services more accurately.

For example, you previously would have coded a brachial plexus injection with 64415, but the code didn't fully report the situation if the anesthetic was repeatedly administered. "If you billed 64415 for each injection, you would be grossly overestimating the work value because that code is supposed to include establishing the block," Groudine explains. "But to bill only for the first injection would say there was no work value in subsequent injections, and that's wrong."

The new catheter codes for continuous infusion of these blocks attempt to correct this problem. The new codes include the postprocedure management (as most surgical codes do), so they have a higher base value than the general code for anesthesia daily management (01996, Daily management of epidural or subarachnoid drug administration). This should eliminate much of the coding confusion, because you report only one code for the catheter's use on multiple days.

Many coders presume that carriers will no longer allow payment for any subsequent catheter management. Details such as whether providers could (or should) charge for additional daily management in certain situations will need to be worked out with individual carriers.

Gillespie adds that because the new codes for continuous service include daily management, physicians must consider what the typical length of management time is and include these costs in their fees and arguments for reimbursement.