Neurology & Pain Management Coding Alert

PM/Anesthesia teams aren't affected by bundles.

The latest edits from the Correct Coding Initiative (CCI 16.3) state that coders cannot report anesthesia with new Category III transforaminal epidural injections. This information, reported in "New 0228T-0230T Codes Already Appear in CCI Edits" (Anesthesia Coding Alert Vol. 12, Number 10), holds true for single-provider encounters. Your coding can change, however, when the procedure involves two providers.

The codes affected by the bundles include 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) and 01992 (... prone position) when paired with new transforaminal epidural injections:

• 0228T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level
• 0229T -- ... each additional level (List separately in addition to code for primary procedure)
• 0230T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level
• 0231T -- ... each additional level (List separately in addition to code for primary procedure).

"Edit bundles exist when the same surgeon is providing both services," explains Leslie Johnson, CCS-P, CPC, director of coding and education for Medi-Corp., Inc., of New Jersey. "The anesthesiologist can't monitor the patient and do the injection at the same time."

Instead, the anesthesiologist might administer moderate conscious sedation in order to perform the injection -- and report the moderate sedation service with 99144 (Moderate sedation services (other than those services described by code 00100 -- 01999) provided by the same physician performing the diagnostic or therapeutic service...). If the case calls for monitored anesthesia care (MAC), "they'll usually call another anesthesiologist in" to help, Johnson says.

When the case involves two providers, the CCI bundles no longer apply to the services in question. The NCCI manual indicates that the bundling edits are only applied to same day services by the same provider to the same beneficiary. The anesthesiologist reports MAC anesthesia service and the other physician (pain management specialist, neurologist, etc.) reports the transforaminal epidural injection.