Anesthesia Coding Alert

A new section introduced in CPT 2002 includes a set of Category III codes temporary codes for reporting emerging technologies, procedures and clinical trials. The CPT manual states that these codes are to be reported in place of a Category I unlisted-procedure code when possible. Alphanumeric nomenclature distinguishes

Category III codes from other CPT codes.
 
Two Category III codes are related to pain management:

0019T Extracorporeal shock wave therapy; involving musculoskeletal system

0020T involving plantar fascia.

Note: Cross-references to these codes appear in both the musculoskeletal system/surgery and medicine chapters of the Category I section of the CPT under the heading "Other Procedures."
 
Cynthia Thompson, CPC, senior consultant with Gates, Moore & Company, a healthcare consulting firm in Atlanta, thinks that the inclusion of Category III codes in CPT benefits pain management practices. "These codes eliminate the need for coders and billers to use unspecified codes for these treatments. Greater specificity in coding will help AMA, CMS and other entities gather data that is pertinent to the procedures that physicians are actually performing." According to CPT 2002, Category III codes may or may not eventually receive a Category I code, a determination that is based in part on reporting frequency.
 
According to the rationale provided in CPT Changes 2002: An Insider's View, 0019T may be used to report ESWT therapy for near bone pain. Therapy can (and often does) include repeat treatments. The code uniformly applies to treatment of different anatomic sites, eliminating the need for multiple codes representing different body regions.
 
Code 0020T can be used to report devices for administering this noninvasive form of pain therapy associated with chronic plantar fasciitis (728.71).
 
According to Thompson, 0019T and 0020T are carrier-priced codes. "The 2002 resources for the resource-based relative value scale (RBRVS) show a relative value unit (RVU) of 0 for each of these codes, indicating that individual carriers are responsible for establishing the reimbursement level. The carrier evaluates claims on a case-by-case basis. The resources instruct that as much documentation as possible must be included with every claim to assist in determining reimbursement. This documentation should include an operative report, a complete description of the procedure, RVU information for similar procedures, and the provider's charges."
 
Pain management practitioners who have treated patients with ESWT have noted that the procedure can be painful. Some patients may require anesthesia, such as a nerve block. Thompson advises, "Most carriers will not cover anesthesia unless it is deemed medically necessary. Documentation accompanying the claim, therefore, should indicate if and how an anesthetic agent was administered, and the rationale for its medical necessity."