Anesthesia Coding Alert

Dorsal (or spinal) column stimulation (DCS) is a treatment for patients with chronic, intractable pain that has not responded to other treatments. DCS interrupts the flow of nerve signals to the brain, replacing pain with a tingling sensation. When deemed medically necessary, DCS is reimbursable by Medicare and most private insurers. However, local Medical review policies (LMRPs) and many private carriers provide detailed limits on coverage. Further, one anesthesiologist (as a pain management specialist) may perform the surgery while another anesthesiologist administers anesthetic for this staged procedure. For anesthesia coders and billers, pain relief comes in knowing how to code correctly for the anesthesiologists' services for each stage of the procedure, and coders must know what documentation is needed to meet the carriers' criteria for coverage.
 
In the first stage of the procedure, electrodes are inserted into the epidural space next to the spinal column, and an external device generates electrical impulses to the electrodes. The patient is monitored to determine the efficacy of treatment. If the trial succeeds, a spinal neurostimulator pulse generator is inserted subcutaneously and connected to the implanted electrodes. Follow-up care includes electronic analysis of the implanted neurostimulator pulse generator system and may include subsequent intraoperative reprogramming or replacement of the pulse generator.
Patients Must Meet Treatment Criteria  
Devona Slater, CMPC, president of Auditing for Compliance and Education Inc., a consulting firm in Leawood, Kan., that focuses on physician compliance plans and anesthesiology and pain management, says patients should be carefully selected for DCS treatment because of the strict limits of coverage for the procedures. She suggests that patients meet the following criteria:
  exhibit a demonstrated pathology
  fail to respond to more conservative therapies
  not be candidates for further surgical intervention
  are free of serious drug problems/habits
  have undergone a psychiatric evaluation
  have predominately radiating extremity pain.
 
Most LMRPs also require that the facilities, equipment and professional support personnel required for the proper diagnosis, treatment training, and follow up of the patient be available, and that demonstration of pain relief with a temporary implanted electrode precedes permanent implantation.
 
According to the LMRP for Empire Medical, New York's Part B Medicare carrier, ICD-9 code lists may cover a range and include shortened codes. It is the coder's responsibility to avoid shortened codes by selecting a code(s) carried out to the highest level of specificity. It is not enough to link the procedure to a correct and payable diagnosis."
 
Slater says that patients likely to meet these criteria may present diagnoses such as arachnoiditis (322.2), neuralgia/neuritis (723.4, 724.3-4, [...]