Anesthesia Coding Alert

Edits bundle sequential IV push with central line placements, epidurals

If your group routinely places lines for central venous access, administers epidural injections or performs epidural blood patches, don't miss how the new National Correct Coding Initiative (NCCI) edits could affect your practice.

An earlier version of NCCI paired three HCPCS G codes with the bulk of anesthesia procedures. NCCI, version 11.2, (effective July 1) continues this trend by listing the same codes as components of many other procedures, some of which are standard fare for anesthesia practitioners. The G codes being bundled into so many procedures are: G0351 - Therapeutic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

G0353 - Intravenous push, single or initial substance/drug

G0354 - Each additional sequential intravenous push (list separately in addition to code for primary procedure). You'll need to be aware of the G code bundles the next time your anesthesiologist deals with central venous access devices. NCCI 11.2 lists all three of these G codes as components of codes for these central venous access procedures: Insertion of central venous access device (including tunneled, non-tunneled and peripherally inserted catheters), 36555-36571

Repair of central venous access device, 36575-36576

Partial or complete replacement of central venous access device, 36578-36585

Removal of central venous access device, 36589-36590

Mechanical removal of obstructive material, 36595-36596. "CPT states that vascular injection procedures include the necessary local anesthesia, introduction of needles or catheter, injection of contrast, and/or any necessary pre- and postinjection care," says Cindy Smith, CPC, of Professional Healthcare Billing Services in Charleston, W.V.

Remembering this - as well as the guidelines for reporting the highest-base procedure during a session - should help you submit claims that account for these edits.
 
"The physician inserts the line for a reason," Smith adds. "He uses it for monitoring or for access for fluids, whether with single or multiple drugs, whether IV push or drip. The line insertion is the most extensive procedure and should be what is billed."
 
'Most Extensive' Codes Also Include Epidurals, Blood Patches The latest round of edits also bundles G0351 into the four epidural injection codes: 62310 - Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic

62311 - ... lumbar, sacral (caudal)

62318 - Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic

62319 - ... lumbar, sacral (caudal).  This bundle should [...]