Anesthesia Coding Alert

3 anesthesia changes affect your everyday coding  A recent provider bulletin from UnitedHealthcare (UHC) included some need-to-know updates for anesthesia practices. Check these three areas to be sure your UHC claims follow the carrier's latest guidelines. 1. Rely on Modifier 59 Again   CPT includes modifier 59 (Distinct procedural service) as a way to help you report -- and receive reimbursement for -- procedures that are separate and distinct from other services performed on the same day (such as administering a pain relief injection after the patient's surgery).
 
UHC has reversed its stance on allowing modifier 59 with 79 procedures your providers might perform on the same day as anesthesia services. Thanks to the change, don't automatically add modifier 59 to some of your most common injections, including:

• 62310-62311 -- Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic; and ... lumbar, sacral (caudal)

• 62318-62319 -- Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic; and ... lumbar, sacral (caudal)

• 64412-64425 -- Various sites for Injection, anesthetic agent to somatic nerves

• 64445-64450 -- Single injection or continuous infusion of anesthetic agent to the sciatic, femoral, lumbar plexus and other peripheral nerves.  "I think this change is probably because of the number of appeals on this service," says Tammy Reed, CPC, anesthesia coding supervisor for Oklahoma Health Sciences Center in Oklahoma City. "Sometimes there is a tendency to think that anesthesiologists bill inappropriately for post-op pain blocks when they used the block as the mode of anesthesia. This just isn't the case. There are legitimate reasons why physicians place blocks and epidurals for pain management, especially when they're caring for multi-trauma patients and pediatric patients."
 
Bottom line: Check UHC's guidelines before reporting modifier 59 with injections or other services your physicians might provide on the same day as the procedure. Visit www.unitedhealthcareonline.com to see the latest guidelines.
 
2. Resident Supervision Requirements Change According to previous versions of UHC's resident supervision policy, you could only report modifier GC (This service has been performed in part by a resident under the direction of a teaching physician) for resident services.
 
Now the revised policy states that modifier GC is an "informational" modifier rather than a required anesthesia modifier. Because of this, you must now report modifier GC with the appropriate modifier for the anesthesiologist's service: AA (Anesthesia services performed personally by anesthesiologist) or [...]