Anesthesia Coding Alert

As every anesthesia and pain management coder knows, CMS updates can contain helpful surprises that can make your job a little easier. The latest update has just been issued, and this one is no exception to the rule. Let our experts tell you about what these changes mean to you.

Bilateral Status Indicators Are in for Big Changes

"Effective April 1-- with the second-quarter change implementation -- many of your 644xx somatic nerve procedure codes are changing their bilateral status indicator to 1," which means Medicare will allow you to report bilateral services and will process them for payment, says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, with MJH Consulting in Denver.

"Previously, these codes carried a 0 status indicator, which meant that whether you reported the code with modifier 50 (Bilateral procedure) or with the modifiers RT and LT (Right side and Left side), Medicare would only allow processing of a single injection," Hammer says.

Opportunity: This is a prime example of how a little legwork can help you play it safe. "Always check with the Medicare Physician Fee Schedule Data Base," says Annette Grady, CPC, CPC-H, CPC-P, CCS-P, compliance auditor at The Coding Network, and executive officer on the AAPC's National Advisory Board. It's a simple way to keep up with the "indicators letting you know which codes are valued as unilateral and modifier 50 is applicable, and which ones are already valued as bilateral and no modifier 50 is indicated," she says.

Tip: You can search the fee schedule online at http://www.cms.hhs.gov/pfslookup/.

How can CMS possibly improve on these changes? The news gets even better, Hammer says. CMS made the changes retroactive to Jan. 1.

She notes that some of the-procedures listed include the following:

• 64405 -- Injection, anesthetic agent; greater occipital nerve

• 64415 -- ... brachial plexus, single

• 64416 -- ... brachial plexus, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration

• 64425 -- ... ilioinguinal, iliohypogastric nerves

• 64447 -- ... femoral nerve, single

• 64448 -- ... femoral nerve, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration.

Where to look: A complete list of the codes that this change affects begins on page 6 of the transmittal. Check it out on the CMS Web site at http://www.cms.hhs.gov/transmittals/downloads/R1482CP.pdf.

Don't count your coding chickens before they hatch, though. In spite of all this good news, there may still be one potential setback you need to be aware of.

"We need to remember that, although these changes are applicable to Medicare for 2008 dates of service, many commercial payers only update their fee schedule files annually," Hammer says. She says that many payers may not implement any of these changes until January 2009 at the earliest.

There's still one more important reason for many coders to be excited. For coders who are looking at reporting the category II tracking codes -- or those coders-who already do so -- this latest CMS update also includes-a new-tracking code series -- 1130F-1137F. Each of the new codes in this series is designated to capture specific performance measures related to back pain and function assessment.-

What you'll use the codes for: Code 1130F (Back pain and function assessed, including all of the following: Pain assessment and functional status and patient history, including notation of presence or absence of "red flags" [warning signs] and assessment of prior treatment and response, and employment status) is the sole new code from this series designated specifically for function assessment, while you use the remainder of the codes -- 1134F through 1137F -- to describe specific durations for periods of back pain.

Where to find them: You can find a complete list of the specific codes and their descriptions-on page 8 of the transmittal (http://www.cms.hhs.gov/transmittals/downloads/R1482CP.pdf).