Anesthesia Coding Alert

Released in November 2001, the 2002 version of CPT includes many changes that affect anesthesiology coding and billing. While the introductory anesthesia guidelines remain unaltered, the anesthesia section contains a new subsection, 19 new codes, 13 deleted codes, and eight revised definitions. Barbara Johnson, CPC, MPC, professional coder, Loma Linda University Anesthesiology Medical Group Inc. of Loma Linda, Calif., states, "It is apparent that anesthesia has been hit hard with new and revised codes. These changes will help coders accurately report services, and, depending on the base units applied, should better reflect the work done by anesthesia providers."
 
While CPT 2002 is effective Jan. 1, 2002, CMS and private payers have until March 31, 2002, to implement the updated codes. Not all payers adopt changes uniformly. You should check with your local Medicare carrier and private insurers before using any of the revised codes.  

A big change within the anesthesia section is a new subsection for obstetrics, containing eight new codes:

01960 anesthesia for; vaginal delivery only

01961   cesarean delivery only

01962   urgent hysterectomy following delivery

01963   cesarean hysterectomy without any labor analgesia/anesthesia care

01964 abortion procedures

01967 neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor)

+01968 cesarean delivery following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure)

+01969 cesarean hysterectomy following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure).

Scott Groudine, MD, an anesthesiologist in Albany, N.Y., says, "The specific surgical and anesthesia problems of the pregnant woman warrant special treatment. In fact, providing care for obstetrical patients actually requires the anesthesiologist to treat two patients mother and child.
 
"Many women start off requiring a labor epidural and during labor, for a variety of reasons, might progress to a cesarean section," Groudine says. "The new codes +01968 and +01969 will be especially useful in clarifying what services were performed. For example, prior to the creation of these codes, billing for the labor epidural and c-section independently would overestimate the work value, as some of the services for the c-section would be included with the labor epidural. Billing only the c-section might warrant review by the carrier due to the seemingly unusual number of hours for the epidural. Billing only the labor epidural would justify the time but severely underestimate the operative and postoperative work associated with an urgent c-section. The uncertain nature of obstetrics justifies not only new CPT codes that reflect procedures that begin as routine but become more involved but a higher base value for these procedures as well. It is good to see a subsection of the CPT addressing these circumstances."

The radiological procedures subsection has been significantly rewritten for 2002. In fact, only 01922 (anesthesia for non-invasive imaging or radiation therapy) remains the same.
 
One new code, 01905 (anesthesia for myelography, diskography, vertebroplasty), replaces 01904, 01906, 01908, 01910, 01912 and 01914. Other new codes include:

01924 anesthesia for therapeutic interventional radiologic procedures involving the arterial system; not otherwise specified

01925 carotid or coronary

01926 intracranial, intracardiac, or aortic

01930 therapeutic interventional radiologic procedures involving the venous/lymphatic system (not to include access to the central circulation); not otherwise specified

01931 anesthesia for; intrahepatic or portal circulation (e.g., transcutaneous porto-caval shunt [TIPS])

01932 intrathoracic or jugular

01933 intracranial.

In addition to the new codes listed above, 01916 is now defined as "anesthesia for diagnostic arteriography/ venography" and cannot be reported with therapeutic codes 01924-01926 and 01930-01933. Code 01920 is slightly redefined, with "angiography" substituted for "arteriography." And, 01921 (anesthesia for angioplasty) has been deleted. Coders and billers should use 01924-01926 to report these procedures.
 
"Interventional radiology is expanding by leaps and bounds, but inconsistencies exist in how to code for services," Groudine notes. "As an example, billing for TIPS procedures has been at issue. Multiple ways were acceptable, depending on the carrier. CPT 2002 has assigned a specific code for transcutaneous porto-caval shunt (TIPS) (01931) providing a uniform way to code and bill. New codes 01925-01933 also break out interventional radiologic procedures that have more work associated with them (intracranial, intrahepatic) from the more generic 01924."

While the obstetrics and radiological procedures subsections contain the most significant number of code changes and revisions, other subsections are also affected.

Under 00600 (anesthesia for procedures on cervical spine and cord; not otherwise specified), coders and billers are advised to see radiological procedure 01905 for reporting myelography and diskography. As noted above, 01905 replaces 01906-01914.

One new code is included: 00797 (anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity).

Two new codes have been added:

00851 anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection

00869 extraperitoneal procedures in lower abdomen, including urinary tract; vasectomy, unilateral/bilateral.

Four codes have been deleted because the procedures are now defined under the obstetrics and radiological procedures subsections:

00850 anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; cesarean section

00855   cesarean hysterectomy

00857 neuraxial analgesia/anesthesia for labor ending in a cesarean delivery (includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor)

00884 anesthesia for procedures on major lower abdominal vessel; transvenous umbrella insertion.

To report these procedures, use 01961 for 00850, 01963 for 00855, 01968 and +01969 for 00857, and 01930 for 00884.

Codes 00946 (anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix or endometrium; vaginal delivery]) and 00955 (neuraxial analgesia/ anesthesia for labor ending in a vaginal delivery ) have been deleted. Again, these codes are now included under obstetrics. To report these procedures, coders and billers should use 01960 for 00946, and 01967 for 00955.

The definition for 01951 now reads "anesthesia for second and third degree burn excision or debridement with or without skin grafting, any site, for total body surface area (TBSA) treated during anesthesia and surgery; less than four percent total body surface area." The code previously referenced excision and debridement for less than one percent of body surface area.
 
Code 01952 has been modified as well. It is now defined as " between four and nine percent of total body surface area." The base unit value of this code has been increased to five units, reflecting the increased amount of work associated with burns greater than four percent of TBSA.

Throughout the anesthesia section, the definitions for six codes have been slightly modified. This follows suit with verbiage changes begun in CPT 2001 (spinal became cerebrospinal, pericardium became pericardial sac, arteriography became angiography, and knee replacement became knee arthroplasty).
 
Code 00220 is now defined as "cerebrospinal fluid shunting procedures" specifying cerebrospinal for spinal.
 
The definition for 00560 now reads "anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator." The code previously referenced pericardium.
 
Code 00942 has been modified to read "anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium; colpotomy, vaginectomy, colporrhaphy, and open urethral procedures)." Vaginectomy replaces colpectomy.
 
The definition for 01214 has been changed to "anesthesia for open procedures involving hip joint; total hip arthroplasty" from total hip replacement.
 
Similarly, 01402 now reads "anesthesia for open procedures on knee joint; total knee arthroplasty" rather than total knee replacement.
 
Code 01995 has been expanded to read "regional intravenous administration of local anesthetic agent or other medication (upper or lower extremity)" rather than the abbreviated IV administration.

Although some minor revisions exist within the E/M-services section, one change in particular may be of interest to anesthesiologists. Critical care code 99292 will now be used to report additional 30 minutes beyond the first 74 minutes. The example table illustrating the correct reporting of critical care services has been revised to include information on billing periods of 194 minutes and beyond.

Although modifier -60 (altered surgical field) was introduced in CPT 2001, it has been deleted for 2002. This modifier was never accepted by CMS or private carriers. A description for modifier -22 (unusual procedural services) has been fully revised. Modifier -22 may be used for services greater than those usually required for a procedure (including an altered surgical field), although Groudine notes that there is some disagreement on whether to use one CPT code for unusual surgery with a -22 modifier, a more comprehensive code with modifier -52 (reduced services), or an unlisted-procedure code. "Usually modifier -22 is selected when there is no good code to describe the procedure or level of work done," Groudine says. As in the past, documentation (surgical and anesthesia records) and a request for additional reimbursement should accompany all claims when modifier -22 is appended.
 
While the information in this article relates primarily to changes within the anesthesia section of CPT 2002, anesthesiology providers, coders and billers are faced with unique challenges when it comes to claims for service. "CPT 2002 has hundreds of edits. While many of these are definition revisions, a number of new codes have been introduced," Johnson says. "Because anesthesiologists provide care in conjunction with so many different areas of medicine, it's important that physicians, coders and billers become familiar with all of these changes."