Anesthesia Coding Alert

Version 9.1 of the National Correct Coding Initiative (NCCI) edits, which became effective April 1, continues the recent trend of bundling pain management injection codes with other services. Other changes of interest relate to the codes for upper and lower gastrointestinal (GI) anesthesia and nonmutually exclusive deletions that tie in with many anesthesia codes. Nonmutually exclusive edits apply to services that a physician might perform during the same care session but that aren't billable together. This is because one of the codes (the component code) is included in the services represented by the second (comprehensive) code of the pairing. You can bill individual components if the physician does not perform the entire comprehensive procedure. But if the physician performs the entire (comprehensive) procedure, you should bill the comprehensive code instead of the individual parts or components. New Edits Bundle Upper and Lower GI Anesthesia With Procedure The new CCI edits bundle anesthesia codes for upper and lower GI endoscopic procedures with the GI procedures. Code CPT 00740 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum) is now a component of several endoscopic procedures. All edits in these groups apply to diagnostic procedures as well as surgical procedures with biopsy, removal of foreign body, control of bleeding, and removal or ablation of tumors or other lesions by various techniques. The edits also encompass other procedures specific to the treatment area transendoscopic stent placement, decompression of volvulus, submucosal injections, balloon dilation, ultrasound examination, and ultrasound-guided aspiration/biopsy.

The procedures affected by this edit include:
Colonoscopy procedures approached through the stoma (codes 44388-44397)
All rigid proctosigmoidoscopy procedures (codes 45300-45327)
Flexible sigmoidoscopy procedures (codes 45330-45345)
Rigid or flexible colonoscopy (45355, Colonoscopy, rigid or flexible, transabdominal via colostomy, single or multiple) and related codes (45381, Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injections[s], any substance; and 45386, with dilation by balloon, 1 or more strictures)
All anoscopy procedures (46600-46615). These procedures rarely require anesthesia other than conscious sedation (99141, Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation), so the edits won't affect coding for most cases. On the other hand, it does mean that you can no longer bill anesthesia separately when you use it for procedures involving children or mentally ill patients or for other unusual circumstances. In other endoscopy-related edits, CCI now considers 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum) a component of new codes 43201 (Esophagoscopy, rigid or flexible; with directed submucosal injections[s], any substance) and 43236 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed submucosal injection[s], any substance). More Nerve Blocks and Injections Edited Pain [...]