Anesthesia Coding Alert

Ambulatory surgical centers (ASCs) have been experiencing problems getting paid for pain management services. Knowing the filing options and how to use existing codes will help physicians receive proper reimbursement.

Earlier this year, ASCs began telling anesthesiologists that Medicare no longer will pay a facility fee for pain management procedures such as certain epidurals and nerve blocks. Because of this, the ASCs informed anesthesia providers that these services should no longer be performed in their facilities. This opinion was based on the fact that the Health Care Financing Administration (HCFA) had not sent carriers an updated list of procedures that generate a facility fee. Many ASCs were still using the 1999 information. The new (and some of the revised) epidural and nerve block codes from CPT 2000 were not on the 1999 list of approved ASC procedures, so they began to balk at the procedures being performed. Coding professionals advise anesthesiologists to work closely with their local carriers to keep current on the information they have received from HCFA and to determine the best method for obtaining outstanding reimbursement.

Which Codes Were Affected?

According to information some carriers received as recently as June 2000, a number of epidural and nerve block codes are still not included on the list of approved ASC services. These include:

Code 62281 (injection/infusion of neurolytic substance)[e.g., alcohol, phenol, iced saline solutions] with or without other therapeutic substance; epidural, cervical or thoracic)
Code 62284* (injection procedure for myelography and/or computerized axial tomography, spinal [other than C1-C2 and posterior fossa])
Code 62287 (aspiration or decompression procedure, percutaneous, of nucleus pulposus off intervertebral disk, any method, single or multiple levels, lumbar [e.g., manual or automated percutaneous diskectomy, percutaneous laser diskectomy])
Codes 64470-64472 (injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic; single level/each additional level)
Codes 64479-64484 (injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level or each additional level; or lumbar or sacral, single level or each additional level)

Know the Filing Options

Carriers have two options for handling claims in this situation. They can hold all claims for services provided after Oct. 1, 1999, until their systems are updated to include the new codes and payment rates, or they can pay claims as they are filed and adjust payment rates later.

Terri Hartwig, a medical coder specializing in anesthesia and surgery with the multispecialty group Watson Clinic in Lakeland, Fla., recommends that anesthesia providers work closely with their local carriers to know how their claims are being handled. Developing an amicable telephone relationship is important. If your carrier is holding on to every pain management claim you send with these codes, you may want to keep them and send a single batch once the carriers system is updated, she says. That may make it easier for you and your carrier to track individual cases and know which ones have been paid vs. ones outstanding.

But if your carrier is willing to reimburse cases as theyre filed and make adjustments once their system is updated, you may want to go ahead and file now, she adds. Just be sure to keep clear documentation that the services arent being paid at the new rate so youll hopefully not have any problems getting the additional amounts later.

Codes to Use in the Meantime

Some coding professionals recommend that ASCs file with Medicare using the old spinal injection codes such as 62274 (injection of diagnostic or therapeutic anesthetic or antispasmodic substance[including narcotics]; subarachnoid or subdural, single) or 62275 (injection of diagnostic or therapeutic anesthetic or antispasmodic substance[including narcotics]; epidural, cervical or thoracic, single.) until carriers have the new information. If the ASC where your group practices decides to do this, your anesthesia providers also may need to file with the old codes to keep the claims consistent.

Are Updated Lists on the Way?

Many anesthesia coders are unsure about which codes to use and many ASCs still do not have up-to-date information. Others are working through the problems and are beginning to receive updated information. Hartwig says she received a new list of ASC approved codes in the spring and has not had any problems with filing claims since then. The information she received does list some of the new epidural codes as approved for use in surgical centers. These include codes 62310, 62311, 62318, 62319 (epidural injections) and codes 64475-64476 (nerve blocks). Work with the facility in which your anesthesia team is providing services to determine which list of approved codes they are using so that you can get reimbursed for your portion of the procedure.

At first glance, anesthesia providers may not pay much attention to the ASC changes because its a facility issue, says Barbara Johnson, CPC, MPC, an anesthesia coder in Loma Linda, Calif., and member of the National Advisory Board of the American Academy of Professional Coders. Physicians arent directly involved, but they are affected since they are providing services and not getting paid. The new ASC payment classifications will affect their relationship with ASCs and some of the surgeries or cases they perform in those settings. Changes are coming, and anesthesia providers need to be aware of them since their practices will be affected.