Anesthesia Coding Alert

Note: These code changes and additions are not yet finalized. The AMA CPT Advisory Committee will meet Nov. 14-15 to review the code changes and make its final determination on new codes for 2003.

Once again, the anesthesia section of CPT Codes has major changes in store for 2003. The newest version of CPT, scheduled for release this month, has 10 new codes, 16 revisions and one deletion in the anesthesia section.

"We need coding changes every year to help us further specify the surgical procedures and risks involved in providing anesthesia," says Jann Lienhard, CPC, a consultant with Solutions for Management in Plymouth Meeting, Pa. "Codes were so general in the past that indicating differences between major and minor procedures and getting appropriate reimbursement were difficult because they were coded the same." But this year's CPT Updates take steps toward remedying that situation.

CPT 2003 is effective Jan. 1, 2003, although CMS and private carriers have until March 31, 2003, to implement the new codes. But Lienhard cautions that not all payers adopt changes uniformly (and some commercial and workers' compensation carriers still require surgical instead of anesthesia codes), so it's important to check with your local Medicare and private carriers before using any of the revised codes.

New Anesthesia Codes Fill Reporting Gaps

Many of the new anesthesia codes for 2003 correspond to existing codes and make reporting of services even more specific. New codes include:
 

00326 Anesthesia for all procedures on the larynx and trachea in children less than 1 year of age (Do not report 00326 in conjunction with code 99100). This code (and several other new ones) will be especially helpful to coders in children's hospitals or whose practices treat many children. In the past, code 99100 (Anesthesia for patient of extreme age, under one year and over seventy [list separately in addition to code for primary anesthesia procedure]) would often be billed in addition to the procedure code for a patient this young. But you can no longer do that since the new code incorporates the risk of caring for a young child in the code's base value.

00539 Anesthesia for tracheobronchial reconstruction

00541 Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including thoracoscopy); utilizing one-lung ventilation. This is a welcome addition to anesthesia coding as one-lung ventilation becomes a more common procedure. "One-lung ventilation often requires more work by the anesthesiologist," says Albany, N.Y., anesthesiologist Scott Groudine, MD. "This CPT change acknowledges the increased mental and physical work that often accompanies one-lung ventilation." This increased difficulty is evidenced by a base value of 15, where associated code 00540 (Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum [including thoracoscopy]; not otherwise specified) has a base value of 12.

00640 Anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic or lumbar spine

00834 Anesthesia for hernia repairs in lower abdomen not otherwise specified, under 1 year of age (Do not report 00834 in conjunction with code 99100). "It's good to see some of the new codes being identified according to the patient's age," Lienhard says. "Many carriers don't recognize the physical status codes for patients, so this enables the proper degree of anesthesia difficulty to be included in the procedure's base units."
 

00836 Anesthesia for hernia repair in the lower abdomen not otherwise specified, infants less than 37 weeks gestational age at birth and less than 50 weeks gestational age at time of surgery (Do not report 00836 in conjunction with code 99100). "Preemies often require more work and care than bigger babies," Groudine says. "A very premature baby should be hospitalized overnight after a hernia repair, whereas a full-term baby could go home. Having specific codes for preemies helps document the need for this."
 

00921 Anesthesia for procedures on male genitalia (including open urethral procedures); vasectomy, unilateral/bilateral

01829 Anesthesia for diagnostic arthroscopic procedures on the wrist. This code and many of the revised codes for anesthesia during various arthro-scopic procedures include "diagnostic" in the descriptors. Lienhard and Groudine agree this will help coders in many situations when the procedure is truly diagnostic and does not convert to a surgical procedure. These additions also expand an area that many anesthesia coders thought was lacking new procedures on the wrist, hand or elbow.

01991 Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider); other than the prone position. Many pain management physicians use anesthesia when administering nerve blocks and/or injections, depending on the patient. Because of this, 01991 and the associated code 01992 will probably be used quite often.

01992 prone position. Administering anesthesia to a patient in the prone position is always more difficult since the patient is turned. Maintaining an open airway becomes trickier, and knowing that the patient's face is not easily seen during the procedure makes control important. This new code acknowledges those risks to carriers by informing them of patient position. "These procedures were difficult to code and collect on in the past," Groudine says. "Now they will be easier to code, and Medicare carriers will have to address them adequately."

Revised Codes Help Improve Accuracy

Implementing new CPT codes is like virtually anything else sometimes they look great on paper but need to be refined once they're put into practice or as procedures change. Revisions come to the rescue each year, ensuring that existing codes more accurately reflect the procedures they represent.

The bulk of anesthesia revisions includes minor terminology changes, which are bolded below. Deletions from descriptors are noted with strikethrough.
 

00320 Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; not otherwise specified, age 1 year or older. This code was modified to balance the ages represented by new code 00326.
 

01382 Anesthesia for diagnostic arthroscopic procedures of knee joint

 

01400 Anesthesia for open or surgical arthroscopic procedures on knee joint, not otherwise specified. "There are codes for both arthroscopic and open procedures of the knee," Lienhard notes. "This new code represents the 'middle ground,' perhaps for when both techniques are used during the same session."
 

 01464 Anesthesia for arthroscopic procedures of ankle joint and/or foot

 01622 Anesthesia for diagnostic arthroscopic procedures of shoulder joint

 01630 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified

 01732 Anesthesia for diagnostic arthroscopic procedures of elbow joint

 01740 Anesthesia for open or surgical arthroscopic procedures on of humerus and the elbow; not otherwise specified. Why was "humerus" deleted from the descriptor? Groudine explains that the revised codes help describe whether the proximal or distal humerus is involved in the procedure. The proximal humerus is involved in the shoulder joint, and the related anesthesia is similar to that for shoulder work; code 01630 is used for these procedures. Procedures involving the distal humerus are similar in work value to the elbow joint and are represented by codes 01732 and 01740. Lienhard also points out that the revisions to this code and 01732 now allow specific codes for diagnostic procedures on the elbow versus arthroscopic procedures.
 

 01830 Anesthesia for open or surgical arthro-scopic/endoscopic procedures on distal radius, distal ulna, wrist, or hand bones joints; not otherwise specified 

 01961-01969 Codes related to anesthesia for obstetric situations. When obstetrical anesthesia codes were added to CPT 2002, most were listed under the common code 01960 (Anesthesia for; vaginal delivery only). Now each code includes "Anesthesia for" in the descriptor.
 

 01996 Daily hospital management of epidural or subarachnoid continuous drug administration (Report code 01996 for daily hospital management of continuous epidural or subarachnoid drug administration performed after insertion of an epidural or subarachnoid catheter placed primarily for anesthesia administration during an operative session, but retained for post-operative pain management). "Virtually everyone who bills 01996 knows they should bill it in a hospital setting and that it can be billed the day after insertion (postoperative day one) because the code for insertion includes management of the catheter for the first day," Groudine says. "This just restates more plainly the current practice of most competent practitioners." 


Lone Deleted Code Included Elsewhere

Only one anesthesia code was deleted for 2003: 00869 (Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; vasectomy, unilateral/ bilateral). This was actually a new code for 2002 but now is included in the descriptor of new code 00921 in the perineum section.

Note the New Modifier

CPT 2003 includes one new modifier that coders should know about, although its use by anesthesia providers is severely limited: -63 (Procedure performed on infants less than 4 kg: Procedures performed on neonates and infants up to a present body weight of 4 kg may involve significantly increased complexity and physician work commonly associated with these patients. This circumstance may be reported by adding the modifier -63 to the procedure number. Note: Unless otherwise designated, this modifier may only be appended to procedures/services listed in the 20000-69999 code series. Modifier -63 should not be appended to any CPT codes listed in the Evaluation and Management Services, Anesthesia, Radiology, Pathology/Laboratory or Medicine sections.)


"My best advice is for you to read the new codes and definitions very carefully," Lienhard suggests. "The codes are getting more specific, which is always good. We just have to change our ways of coding and look deeper into the procedure to report the correct code and units for the services our anesthesiologists provide. It looks like they cover the gamut of specialties and should help us, once we get comfortable using them."