Anesthesia Coding Alert

Watch for these edits

National Correct Coding Initiative (NCCI) edits that went into effect Jan. 1, 2005 (version 11.0) hit anesthesia practitioners hard with almost 550 nonmutually exclusive pairings classifying various anesthesia services as components of more global procedures - and pain management practitioners also took a hit thanks to the bundling of several new G codes into some commonly used epidural, catheter and injection codes. Apply Latest Edits to New G Codes CMS added four new G codes that allow them to track different types of infusion procedures. The latest version of the NCCI edits classifies these new codes as subject to their corresponding CPT codes:

G0345 - Intravenous infusion, hydration; initial, up to one hour

G0347 - Intravenous infusion, for therapeutic/diagnostic (specify substance or drug); initial, up to one hour

G0351 - Therapeutic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

G0353 - Intravenous push, single or initial substance/drug. These G codes replace therapeutic or diagnostic infusion codes 90780-90784. Previous versions of NCCI edits bundled 90780-90784 into anesthesia codes, so doing the same with the new G codes doesn't surprise many experts.

NCCI assigns a status indicator of "1" to the bundles with codes G0345 and G0347. This means you can report both services of the pair with modifier -59 (Distinct procedural service) to differentiate the procedures and receive payment for both.

However, NCCI assigns a status indicator of "0" to the edits that bundle G0351 and G0353 with the anesthesia codes. Because of this status indicator, you cannot use a modifier to report the services separately, says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C. Pay Attention to Injection Coding, Too NCCI 11.0 bundles three of these G codes (G0345, G0347 and G0353) into epidural and catheter codes and most nerve block and joint injection procedures. Comprehensive codes in these edits include those such as:
  Single injection codes 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) and 62311 (... lumbar, sacral [caudal])

  Continuous infusion codes 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) and 62319 (... lumbar, sacral [caudal])

  Arthrocentesis procedures 20600 (Arthrocentesis, aspiration and/or injection; small joint or bursa [e.g., fingers, toes]), 20605 (... intermediate joint or bursa [e.g.,temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) and 20610 (... major joint or bursa [e.g., shoulder, hip, knee joint, [...]