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 ...), depending on the circumstances.

Note: Evaluating a patient prior to surgery is different from a consult or new patient visit. You report TOS 09 for consults and new visits, but don't report pre-surgical evaluations separately. The global anesthesia fee includes work done during the pre-surgical evaluation and is part of the anesthesia code (designated with TOS 07) you submit for the procedure.

Double-Check When Services Cross TOS Lines

Correctly reporting your physician's specialty designation is especially important when he provides both anesthesia and pain management services instead of focusing on one area--and because some procedures can fall into either camp, depending on the situation.

A prime example is epidural injections. Physicians commonly administer epidurals for labor patients, which qualify as TOS 07 and which you code with:

- 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--Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure performed)

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

A pain management specialist, on the other hand, often uses epidurals to treat spinal problems such as herniated disks, spinal stenosis, bulging or sequestered disks or degenerative disk disease. These injections count as TOS 09, and you should report the procedure 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

- 62311--... lumbar, sacral (caudal)

- 62318--Injection, including catheter placement, continuous infusion or intermittent bolus, 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

- 62319--... lumbar, sacral (caudal).

Watch Injections and Guidance With TOS 09

Because many pain management procedures involve multiple injections or guidance, keep these tips in mind when reporting services as TOS 09.

Count levels: When your physician injects multiple levels of the patient's spine, pay close attention so you code the correct number of units. Also monitor the procedure frequency to be sure your physician doesn't exceed the number of injections allowed per level each year, says Trish Bukauskas-Vollmer, CMM, CPC, owner of TB Consulting in Myrtle Beach, SC.

Check guidance: Note any radiological or guidance procedures the physician completed in case you-re able to report guidance in addition to the pain procedure.

Example: 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction) is strictly for needle placement, so you-ll report it in addition to the code for the epidural, spinal or articular injection.

Exception: Don't add 76005 when you report a RACZ procedure. The RACZ codes 62263 (Percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., catheter] including radiologic localization [includes contrast when administered], multiple adhesiolysis sessions; 2 or more days) and 62264 (... 1 day) include fluoroscopic guidance. 

TOS 09 Can Help at Audit Time

Reporting TOS 09 (Interventional pain specialist) for pain management procedures might decrease your chances of an audit, coding experts say. Interventional pain specialists frequently provide E/M services because their practices require more extensive interaction with and evaluation of patients.

The result: Reporting services with 09 typically doesn't throw up the red flag that E/M services reported with TOS 07 (Anesthesia) might.