Urology Coding Alert

Separate anesthesia billing is a no-no

A new year means new National Correct Coding Initiative (NCCI) edits, and version 10.0 bundles many components for urologists, including many cystourethro-scopy procedures and anesthesia components.
 
The new anesthesia edits deal specifically with two codes introduced in CPT Codes 2004: 53500 (Urethrolysis, transvaginal, secondary, open, including cystourethro-scopy [e.g., postsurgical obstruction, scarring]) and 57425 (Laparoscopy, surgical, colpopexy [suspension of vaginal apex]).
 
The new Ncci Edits have "caught up" with the new CPT Manual by bundling anesthesia components into the procedures, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York Health Science Center in Stony Brook. "These two new codes will add to the surgical arsenal of urologists and urogynecologists alike."
 
The new edits eliminate any doubt that Medicare will not reimburse for anesthesia provided by the urologist.    
The Medicare surgical package for 2003-2004 includes the anesthesia administered by the surgeon within the operative procedure.
 
A frequent example for urologists is a periprostatic anesthetic block for a prostate gland needle biopsy procedure (55700, Biopsy, prostate; needle or punch, single or multiple, any approach).
 
You should not bill for this anesthesia. The Medicare Carriers Manual Section 15018 states that a carrier should not allow separate payment for the anesthesia service performed by the urologist who also furnishes the medical or surgical service.
 
In that case, the reimbursement for the anesthesia service is made through the payment for the medical or surgical service.
 
For example, do not allow separate payment for a  surgeon's performance of a local or surgical anesthesia if the surgeon also performs the surgical procedure.
 
Private carriers may allow these charges. Check with the individual carrier for more information and the coding policy for surgeon-administered anesthesia.
 
The CPT surgical package guidelines do not mention "block anesthesia," and many HMOs and private carriers following CPT surgical-package guidelines will reimburse for surgeon-administered block anesthesia. Do not lose payment for this if it is reimbursable by your carrier.