Anesthesia Coding Alert

Plus: The secret to differentiating lumbar sympathetic destructions When you code for a specialty whose procedures are concentrated in a specific area - such as the lumbar region - you can have a hard time keeping the procedural terminology and corresponding codes straight. Our experts teach you a simple three-step strategy for avoiding this confusion when reporting the different types of diagnostic and therapeutic lumbar procedures. 1. Understand the Differences Many lumbar pain management procedures fall into one of two categories: diagnostic and therapeutic blocks (by single-shot injection or continuous infusion catheter), and destruction/ablation by a neurolytic agent. Your first step in coding correctly is being able to identify each type of service.

Blocks. A physician usually administers a block to provide temporary pain relief for the patient. Some blocks can provide permanent pain relief, as with reflex sympathetic dystrophy patients, says Scott Groudine, MD, an Albany, N.Y., anesthesiologist. Blocks can be single-shot injections or continuous infusion and can be either diagnostic or therapeutic, depending on the circumstances.

Many coders say their physicians administer lumbar blocks for therapeutic reasons more often than as diagnostic tools. Common diagnoses supporting medical necessity for diagnostic blocks include 724.4 (Thoracic or lumbosacral neuritis or radiculitis, unspecified), 724.02 (Spinal stenosis, lumbar region), 722.10 (Displacement of lumbar intervertebral disc without myelopathy) and 724.3(Sciatica).

Nerve destruction/ablation. A physician prescribes destruction to completely "kill" the nerve causing the patient's pain. He uses a chemical, thermal, electrical or radiofrequency agent to achieve the destruction.

Nerve destruction (also known as "denervation") is often one of the physician's last resorts for pain management after other techniques have failed, says Barbara Johnson, CPC, MPC, owner of the consulting firm Real Code Inc., in Moreno Valley, Calif. The complete destruction can be accomplished in one session or over a period of days, but Johnson and Groudine agree that one injection is usually sufficient.

"Most anesthesiologists would not perform neurolysis for trivial pain," Groudine says. "Once alcohol is put on a nerve, that nerve may never function again. Most people use it when the risk/benefit ratio favors extreme measures."

Conditions that may justify nerve destruction can include facet mediated pain (724.8, Other symptoms referable to back), certain types of degenerative disc disease (from the 722.xx series for Intervertebral disc disorders) and small herniated disc (such as spondylosis [721.3] or postlaminectomy syndrome [722.83] without radicular component or pain).

These cases often require additional documentation of failed treatments to help justify the denervation. Example: The patient must have had a previous facet block that proved pain was generated from that level to meet the medical-necessity guidelines for radiofrequency

Local blocks such as steroid injections often need pre-approval and authorization, depending on the carrier. Always check the carrier's guidelines before [...]