Anesthesia Coding Alert

Service location, specific plan can dictate your steps

Precertification and preauthorization requirements can vary depending on the place of service or even the specific insurance plan with a carrier.

Example: The carrier might not require pre-authorization if the physician performs a procedure in an outpatient setting, yet could require it if the physician performs the same procedure for an inpatient. Epidural steroid injections and trigger point injections are two examples of procedures that physicians rarely perform in a hospital without preauthorization.

Report standard ESIs with 62310 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) or 62311 (... lumbar, sacral [caudal]).
 
Report TPIs with 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) and 20553 (... single or multiple trigger point[s], three or more muscles).

By the same token, the carrier might require pre-authorization for a procedure when the physician schedules it in an ambulatory surgery center but not when he plans to perform it in his office.

Also watch for employers who offer different plans from the same carrier, such as an HMO plan and a PPO plan. The HMO and PPO may have different guidelines regarding preauthorizations, precertifications or other procedures and services.

Most carriers will give you a provider manual that details which procedures require preauthorization and how you go through the process, says Tammy Reed, CPC, anesthesia department billing manager for Oklahoma University Health Science Center in Oklahoma City. Many carriers have also gone online, which means you can request precertifications or pre-authorizations on the Internet.