ED Coding and Reimbursement Alert

Gear up for a new array of venous access codes

Revamped radiology, critical care, and venous access codes headline the CPT code changes for 2004 - and more than a handful affect the emergency department (ED). While these codes will officially take effect Jan. 1, 2004, many insurers may not implement them until the beginning of April, so check with your carrier before sending off claims that include these changes. Take a look at the following top ED code changes:

Read the Fine Print for Surgical Services

You'll have new notes and examples to take into account when reporting certain surgical procedures, so make sure you're aware of the accessory information associated with these codes.
 
For instance, code series 11770-11772 (Excision of pilonidal cyst or sinus) now has a note directing you to report 10080-10081 (Incision and drainage of pilonidal cyst) when the physician performs incision and drainage rather than a formal excision. "10080 will represent most of the ED services provided," says Mike Granovsky, MD, CPC, FACEP, chief financial officer of Greater Washington Emergency Physicians in Fort Washington, Md.
 
Pay attention to details when using codes 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]), 20551 (... single tendon origin/insertion) and 20552 (Injection[s]; single or multiple trigger points[s], one or two muscles[s]). Codes 20550 and 20551 have become more specific, now distinguishing between single tendon sheath and single tendon origin. Code 20552 adds the distinction between injections to "one or two muscles," complementing 20553's "three or more muscles."
 
When the physician repairs flexor tendons, you'll only report code 26356 (Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath [e.g., no-man's land]; primary, without free graft, each tendon) for primary repair; 26357 (... secondary, without free graft, each tendon) will describe only secondary repair.

Watch Birthdays for Venous Access Codes

New codes for venous access services separate young children from other patients and distinguish when procedures need a physician's hand. Code 36400 (Venipuncture, under age 3 years, necessitating physician's skill, not to be used for routine venipuncture; femoral or jugular vein), for example, now clearly states "necessitating physician's skill"- so you shouldn't use this code for "routine venipuncture."

And in that vein, for similar patients 3 years or older, you should report revised code 36410 (Venipuncture, age 3 years or older, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes [not to be used for routine venipuncture]), which will reflect the patient's age.
 
Reread CPT's section on venous access codes on page 149 of CPT 2004 because you'll find new codes that clarify insertion, repair, revision, removal, and imaging. Be sure to pay particular attention to these highlighted new arrivals:
  36555 - Insertion of non-tunneled centrally    inserted central venous catheter; under 5 years of age
  36556 - ... age 5 years or older

Note: Because of this new pair of more specific codes, code 36489 (Placement of central venous catheter [subclavian, jugular, or other vein]; percutaneous, over age 2) has left the books. Appendix B on page 386 of CPT 2004 has a complete list of the additions, deletions and revisions.

  36568 - Insertion of peripherally inserted central   venous catheter (PICC), without subcutaneous    port or pump; under 5 years of age
  36569 - ... age 5 years or older
  36580 - Replacement, complete, of a non-tunneled    centrally inserted central venous catheter, without sub-  cutaneous port or pump, through same venous access
 
"This [36580] is for the occasional patient who has a central line that is replaced over a guide wire inserted through the original line," Granovsky says.