Anesthesia Coding Alert

Plus: Don’t overlook the moderate sedation changes.

The American Medical Association (AMA) has released full descriptors and details for CPT® changes for 2017, and you’ll definitely be affected by some as an anesthesia coder. Read on for the news you need to know.

Say Hello to More Options and Details for Epidurals

You’ve spent years reporting your provider’s epidural injections and catheter placements with four reliable codes:

• 62310 -- Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic
• 62311 - … lumbar or sacral (caudal)
• 62318 -- Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic
• 62319 -- … lumbar or sacral (caudal).

That will all change on January 1, however, when CPT® deletes 62310-62319 and introduces eight new replacement codes.

The similarities: The new codes will still be differentiated by anatomic site (cervical/thoracic and lumbar/sacral). They also will continue to represent either a single epidural injection or an indwelling catheter placement.

The differences: The word “interlaminar” has been added to describe the epidural’s placement as either “interlaminar epidural or subarachnoid.” One important deletion is what led to the expansion of choices: the descriptor no longer includes the phrase “includes contrast for localization when performed.”

Each code will now specify whether the provider used imaging guidance. Your choices for single-shot epidurals will be:

• 62320 -- Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
• 62321 -- … with imaging guidance (i.e., fluoroscopy or CT)
• 62322 -- Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
• 62323 -- … with imaging guidance (i.e., fluoroscopy or CT).

The breakdown for continuous infusion or intermittent bolus will be:

• 62324 -- Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
• 62325 -- … with imaging guidance (i.e., fluoroscopy or CT)
• 62326 -- Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
• 62327 -- … with imaging guidance (i.e., fluoroscopy or CT).

“It could be hard to get used to the new epidural codes because we’ve had the other ones for so many years,” says Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. “And, as I understand it, ‘image guidance’ includes ultrasound even though it is not listed in the ‘i.e.’”

Say Goodbye to Some Moderate Sedation Codes

Your anesthesia providers might not have many situations that merit their reporting moderate sedation, but you should still be aware of the options. In a move similar to the one with epidurals, the AMA has deleted some familiar moderate sedation codes and replaced them with new options.

In a nutshell: Moderate sedation codes 99143, 99144, and 99145 will be deleted effective Jan. 1, 2017. Here’s a refresher of what they represent:

• 99151 – Moderate sedation services provided by the same physician or other qualified health care profes­sional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age
• 99152 – … initial 15 minutes of intraservice time, patient age 5 years or older
• 99153 – … each additional 15 minutes intraservice time (List separately in addition to code for primary service).

New tactic: To report moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, you’ll have three new choices:

• 99143 – Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time
• 99144 – … age 5 years or older, first 30 minutes intra-service time
• +99145 – … each additional 15 minutes intra-service time (List separately in addition to code for primaryservice).

As you can see, these descriptors are exactly the same as codes 99151-99153, with one exception: the addition of the phrase “other than those services described by codes 00100-01999.”

Important note: “Previously, the halfway point for time was 16 minutes as defined by CPT®,” Dennis says. “With the time change, the halfway point for time is now 8 minutes, which will allow reporting of moderate sedation services for the procedures that didn’t take 16 minutes to perform.”

“There has long been confusion about whether or not anesthesiologists would ever use these moderate sedation codes,” adds coding educator Leslie Johnson, CCS-P, CPC. “They could, I suppose, but these codes are meant for when whoever is doing the surgical procedure is providing sedation for the procedure and there’s either a physician or a nurse or otherwise ‘trained observer’ who is monitoring the patient’s vitals and condition.”

Johnson shares this example of when an anesthesiologist might use these moderate sedation codes: if/when he or she is doing pain management services and also providing sedation. “They key will be in the level of depth of sedation, which is what those who are administering this sedation should be watchful for,” she says. “Coders won’t be able to determine this without documentation from the clinicians that should indicate the type of sedation (‘moderate’ a.k.a. ‘conscious sedation’ or deep sedation.’”

Coding Edits: Last Edits of 2016 Bring No Real Changes for Anesthesia

Finish the year with no substantial shifts in reporting.

The latest version of Correct Coding Initiative (CCI) edits went into effect Oct. 1, with good news for anesthesia providers and coders: none of the updates should affect your end-of-year claims.

The update did not include any edit pairs with anesthesia codes 00100-01996, or with other codes anesthesiologists use on a regular basis such as 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes).