Anesthesia Coding Alert

Like any year, 2023 has seen its fair share of changes, especially in the world of medical coding. Inevitably, it takes some time to process them all.

So, to help, we’ve recapped four of the biggest shifts in coding practices from 2023, so you can hit the ground running in 2024.

Refresher 1: Somatic Nerve Injection Codes Include Imaging

CPT^® 2023 added “including imaging guidance, when performed” to the descriptors for somatic nerve injection codes 64415-64417 and 64445-64448. That means you should no longer report ultrasound (i.e., 76942, Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) or other types of imaging guidance separately along with those injections. Anesthesia practices often use these injections for postoperative pain management.

This change had anesthesia office staff wondering whether documentation, such as images and a report, still needed to be kept for ultrasounds. “The answer is a resounding yes. Whether or not the code is billed and paid separately, services provided should still be documented,” according to Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, president of Perfect Office Solutions in Leesburg, Florida.

Refresher 2: New Chronic Pain Management Codes in Play

Medicare rolled out two new codes for chronic pain management (CPM) in 2023. The descriptors for these CPM codes are long, and you must read them carefully to understand the requirements. The italicized wording below quotes the code descriptors, but adds bullets in G3002 to make it easier to identify each element:

• G3002 (Chronic pain management and treatment, monthly bundle including,
  o diagnosis;
  o assessment and monitoring;
  o administration of a validated pain rating scale or tool;
  o the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes;
  o overall treatment management;
  o facilitation and coordination of any necessary behavioral health treatment;
  o medication management;
  o pain and health literacy counseling;
  o any necessary chronic pain related crisis care; and
  o ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate.
  o Required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional;
  o first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (when using G3002, 30 minutes must be met or exceeded.))

• G3003 (… Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (List separately in addition to code for G3002. When using G3003, 15 minutes must be met or exceeded.))

As detailed as the code descriptors are, there is a lot more you need to know to apply these codes accurately.

Descriptor elements required: Providers must furnish all appropriate elements of the code descriptor. The key term is “appropriate” because not all patients require every element.

Chronic pain definition: For these codes, Medicare defines chronic pain as “persistent or recurrent pain lasting longer than 3 months.”

At the first visit, the patient doesn’t need to have an established history or diagnosis of chronic pain. The patient also doesn’t need to be diagnosed with a condition that causes or involves chronic pain. However, it is the provider’s responsibility to establish, confirm, or reject a chronic pain and/or pain-related diagnosis when the patient first presents for care and the PM physician first reports G3002.

Face-to-face: The first time you report G3002, a physician or other qualified healthcare professional (QHP) must see the patient in person in a clinical setting. Beyond that, the provider may decide to furnish any in-person components using telehealth to increase patients’ access to care.

Frequency: In conjunction with G3002 for the first 30 minutes, you may report +G3003 for each additional 15 minutes an unlimited number of times per calendar month.

Additional services: You may report both evaluation and management (E/M) and CPM codes on the same day when documentation shows the encounter met all requirements to report each service separately. Similarly, Medicare allows you to report CPM and remote patient monitoring, remote physiologic monitoring, or remote therapeutic monitoring together when documentation supports doing so. Of course, you should not double-count time. Don’t include time spent on another reported service when calculating the CPM time.

Multiple providers? The final rule “noted that it is unlikely that a patient with pain would want or need to see more than two physicians or other qualified health professionals in the same month to manage their pain through CPM, but declined to restrict the number of clinicians who can bill the CPM codes at this time,” according to attorneys Carrie Nixon, Kaitlyn O’Connor, and Stephanie Barnes of Nixon Gwilt Law.

Refresher 3: Discarded Drug Reporting Requirements Revamped

If your practice supplies and reports the drugs administered to patients, you should be familiar with using modifier JW (Drug amount discarded/not administered to any patient) when the provider administers part of a single-dose container and discards the rest. Reporting the discarded amount with modifier JW allows you to receive payment from Medicare Part B for the portion not administered.

When the calendar flipped to July 1, 2023, a new requirement went into effect. You now need to use the novel, related modifier JZ (Zero drug amount discarded/not administered to any patient) when there is no amount of drug discarded from a single-dose container subject to modifier JW rules. While the modifier had an effective date of Jan. 1, 2023, Medicare opted to give providers until July 1 to start using JZ. Claims processing edits began Oct. 1, 2023, with Medicare checking use of both JW and JZ.

Tip: Use modifier JZ on the claim line with the drug code and administered amount.

Refresher 4: Zero In on Z Code Additions

ICD-10-CM 2024 brought significant change to Chapter 21, with 30 new additions and six codes converted to parent. The newly introduced Z codes encompass various aspects such as personal history of military service, newborn observation for suspected conditions ruled out, carriers of bacteria (Acinetobacter baumannii, Enterobacterales), family history of certain colonic polyps, and caregiver noncompliance.

The 2024 update also enhanced the Social Determinants of Health (SDoH) section, providing you with more ways to report notable child-guardian relationships, thanks to new codes like Z62.23 (Child in custody of non-parental relative), Z62.823 (Parent-step child conflict), and Z62.832 (Non-relative guardian-child conflict).