Anesthesia Coding Alert

New edits bundle some venipuncture, G codes

If your anesthesiologists perform TEE (transesophageal echocardiography) procedures or use TEE for monitoring, pay attention to the National Correct Coding Initiative (NCCI) 11.3 edits effective Oct. 1.

The new edits list codes for all aspects of TEE (93312-93318) as the comprehensive component for several pairings that include intravenous push and venipuncture.

The next time you code for TEE, remember that these procedures are now components of the service:

- 36000--Introduction of needle or intracatheter, vein

- 36410--Venipuncture, age 3 years or older, necessitating physician's skill (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)

- G0345--Intravenous infusion, hydration; initial, up to one hour

- G0347--Intravenous infusion, for therapeutic/ diagnostic (specify substance or drug); initial, up to one hour

- G0353--Intravenous push, single or initial substance/drug

- G0354--Each additional sequential intravenous push (list separately in addition to code for primary procedure). These are non-mutually exclusive edits, which means the physician might perform both services during the same session but cannot bill for both.
 
Judy Wilson, CPC, CCP, CMC, CMBS, of Anesthesia Specialists in Virginia Beach, Va., says the edits won't really affect her group. -We would only bill for the more comprehensive service--in this case, the TEE procedures,- she says. The same should hold true for other coders, meaning this round of NCCI edits is more a formality than source of frustration for anesthesia coders. PM Coders, Pay Attention Many of NCCI 11.3's edits address neurolytic injection and destruction procedures common to pain management physicians. A few of the codes listed as components of more global procedures include:

- 64400--Injection, anesthetic agent; trigeminal nerve, any division or branch

- 64448--... femoral nerve, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration

- 64479--Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level

- 64520--Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic). These and many other injection procedures are components of destruction or neuroplasty codes such as 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]), 64708 (Neuroplasty, major peripheral nerve, arm or leg; other than specified) and 64722 (Decompression; unspecified nerve[s] [specify]). 
 
Coding aid: Contact editor Leigh DeLozier at leighdelozier@bellsouth.net if you-d like a reference chart with these pain management-related edits.