2003 Injection Codes Improve Coding Clarity
Published on Sat Mar 01, 2003
CPT 2003 introduced four new somatic nerve block codes, eliminating the need to bill an additional anesthesia code when administering continuous infusion for pain management. In addition, CPT revised several injection code descriptors in the 20550-20605 range, most notably referencing the number of trigger point muscles injected, rather than the former "muscle groups." Unlisted-Procedure Code No Longer for Continuous Infusion The four new nerve block codes will eliminate existing ambiguity, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. "In 2002, the AMAadvised practitioners not to select a CPTcode that merely approximated the services provided and, therefore, mandated use of the unlisted-procedure codes for infusion catheter pain management procedures." The new codes are: 64416 Injection, anesthetic agent; brachial plexus, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration 64446 ... sciatic nerve, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration 64447 ... femoral nerve, single 64448 ... femoral nerve, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration. "Outpatient practices will probably report 64447 more frequently than the other new codes," Hammer suggests. As a single nerve block code, physicians might offer it to patients awaiting surgery, for example. "In the outpatient setting, I could foresee 64447 being used as a diagnostic tool to evaluate possible femoral nerve injuries," Hammer says. The continuous infusion codes (64416, 64446 and 64448) will have more applications in postoperative pain management. Previously, physicians had to report these services using 64450* (Injection, anesthetic agent; other peripheral nerve or branch) and 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration). "The new codes carry a 10-day global period, and the instructions specifically indicate that 01996 should not be reported," Hammer says. More Precision for Trigger Points CPT 2003 modified several injection code descriptors to pinpoint more specifically the area injected. For example, the descriptor for 20550* eliminates the reference to the ganglion cyst and now states, "Injection(s); tendon sheath, ligament."
Similarly, descriptors for 20600* (Arthrocentesis, aspiration and/or injection; small joint or bursa [e.g., fingers, toes]) and 20605* (... intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) also eliminate "ganglion cyst(s)." To compensate, CPTcreated a new code, 20612 (Aspiration and/or injection of ganglion cyst[s] any location). Areference following the descriptor for 20612 indicates that you should report multiple ganglion cyst aspirations and/or injections using 20612 with modifier -59 (Distinct procedural service) appended for the second and subsequent injections.
CPT 2003 offers new descriptors for 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) and 20553 (... single or multiple trigger point[s], three or more [...]
