Anesthesia Coding Alert

Report the right service so claims fly through correctly Whether your physicians focus on a particular area of pain management or cover the gamut of services, don't shortchange your claims by reporting incorrect specialty designations--and thus incurring denials. You-re Covering More Than Basic Anesthesia Years ago, a physician who practiced anesthesia did just that--provided anesthesia during patients- procedures, usually in a hospital setting. You coded claims for the physician's anesthesia service and included -07- (Anesthesia) as your specialty designation (also called the type of service, or TOS) to give carriers a heads-up that your claim was for the anesthesiologist instead of the surgeon. (Codes beginning with -00- also signal anesthesia services, which is sufficient for some carriers instead of including TOS 07.)

But the field has grown tremendously in recent years, and your coding has changed accordingly.

CPT adds more pain-related procedure codes each year. In CPT 2006 alone, you-ve seen new codes for kyphoplasty (22523-22525, 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] ...) and new and revised codes for chemodenervation (64613, Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]; and 64650-64653, Chemodenervation of eccrine glands ...).
 
That makes your procedure coding more accurate, but don't forget to pay attention to the TOS you submit with your claims. You might still rely on -07- for anesthesia services, but be sure to change that designation for pain management procedures. Expect Consults With Pain Specialists Pain management specialists focus on helping patients alleviate chronic pain, rather than relieve acute pain during or after surgical procedures. Report this care with TOS 09 (Interventional pain specialist) instead of TOS 07.

-Our pain specialists mainly see patients for ongoing treatment of chronic pain,- says Julee Shiley, CPC,  CCS-P, CMC, a South Carolina coding consultant. -We typically code more consults and office visits for these physicians than procedures.-

Consult challenge: Your challenge when coding for pain management physicians is knowing the difference between a new patient visit and a consultation for ongoing treatment, Shiley says.

Before you can code this initial visit as a consultation, you must meet--and document--the three consultation criteria: Request for the consultation, review of the patient's situation, and a report of your opinion and findings sent to the requesting physician.

Once a patient encounter meets these criteria, you should code the visit with 99241-99245 (Office consultation for a new or established patient ...), depending on the level of service.

If you don't have the documentation to support coding a consult, you-ll report a new patient visit instead. Choose from 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient [...]