Anesthesia Coding Alert

The pain management codes were completely restructured in CPT 2000 (see Optimize Reimbursement for Tricky New Pain Management Codes, page 17 of Anesthesia Coding Alert, March 2000). Ideally, this should make choosing the best pain management code easier. Descriptors were expanded, new codes were added, and some old codes were consolidated into others. But does the restructuring really make a difference in the trenches? According to Jann Lienhard, a coder with Cash Flow Solutions, a medical billing and consulting company in Lakewood, N.J., anesthesia coders are still struggling with the pain management codes.

Document Thoroughly

Lienhard says that thorough documentation can help get claims paid. Keep good records and try to get written confirmation from the carrier about what theyll pay, Lienhard advises. Thats hard to do, because the carrier may say that their policies arent available for public distribution. Dont be afraid to make waves about it. No one can deny the surgery took place, so do your best to get paid for it.

Although practitioners have been providing pain management services for years, some carriers still tend to be wary of reimbursing for them. While Lienhard acknowledges that pain management is not as cut and dry as treating fractures or hernias, it is becoming a more important part of medicine. Most patients who see a pain management specialist have already run the gamut of other specialists, she says. We are the end of the line for these patients, or at least their last alternative before major surgery. Carriers will hopefully begin to recognize pain management as legitimate, as they eventually did with chiropractors, osteopaths and acupuncture specialists. In the meantime, the best we can do is document the cases thoroughly and be persistent about getting reimbursed for them.

Abdominal procedures are one such area, Lienhard says, can run a bit sticky. The anesthesia codes are not as specific as Id like them to be, she explains. Sometimes the anesthesia code that is cross referenced for a procedure just doesnt seem to be on par with what is done.

For example, code 50605 (ureterotomy for insertion of indwelling stent, all types), code 50320 (donor nephrectomy, open from living donor [excluding preparation and maintenance of allograft]) and code 50340 (recipient nephrectomy [separate procedure]) all cross reference code 00862 (anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper 1/3 of ureter, or donor nephrectomy) as the appropriate anesthesia code to use. But, as Leinhard points out, it seems that the anesthesia code for kidney donor or recipient procedures should be different from the code for inserting a stent to remove a urethral blockage.

Another scenario is when a physician performs multiple procedures on a patient. [...]