Anesthesia Coding Alert

The newest round of Correct Coding Initiative (CCI) edits (8.3) released in October means many changes for anesthesiologists dealing with pain management procedures. Few anesthesia providers will be affected by the mutually exclusive edits, but changes to the comprehensive and component codes are another story. More than 54,000 edits were made to comprehensive and component codes. "Many common procedures for pain management are included in the new comprehensive edits," says Linda Runfola, CPC, an anesthesia and pain management consultant with NAPA Management Services in Syracuse, N.Y., "so it's important to review them carefully. As you find additions to your most common procedures, either highlight them or note them in some way so you can remember the changes."

Component codes are included in services designated by broader-scope comprehensive codes. This means that if you perform the whole (or comprehensive) service, you cannot bill the individual parts (or components). If you don't do the entire comprehensive procedure, you bill the components that were performed.

"The physicians should document everything they do," says Barbara Johnson, CPC, MPC, professional coder with Loma Linda University Medical Group Inc. in Loma Linda, Calif. "The coder will then figure out the highest reimbursement code, what is included in that service, and whether any services are bundled."

Most of the changes to CCI 8.3 include too many comprehensive codes to print complete lists here, but this will give you an overview of what to expect. Get your complete copy of CCI edits from the National Technical Information Service (NTIS, the authorized distributor for CMS) by calling (800) 363-2068. You can also call this number to subscribe to the quarterly updates. Tendon and Trigger Point Injection Codes Now Bundled Anesthesia providers have made great use of the trigger point injection and associated codes introduced in CPT 2002. This group includes:
  20550* Injection; tendon sheath, ligament, ganglion cyst (This code was already in CPT but was revised in 2002 with the addition of three subcodes.)
  20551 tendon origin/insertion

20552 single or multiple trigger point(s), one or two muscle group(s)

20553 single or multiple trigger point(s), three or more muscle groups.
CCI 8.3 lists each of these injection codes as components of many procedures. For example, they have now been bundled with many common nerve injections including 64400* (Injection, anesthetic agent; trigeminal nerve, any division or branch); nerve procedures such as 64834 (Suture of one nerve, hand or foot; common sensory nerve); and radiology procedures such as 72240 (Myelography, cervical, radiological supervision and interpretation), 72295 (Diskography, lumbar, radiological supervision and interpretation) and 76003 [...]