Anesthesia Coding Alert

 Version 11.0 focuses on new codes

Anesthesia providers won't get paid for services associated with more than 30 new CPT codes, according to the National Correct Coding Initiative (NCCI) edits that went into effect Jan. 1, 2005. Almost 550 nonmutually exclusive pairings classify various anesthesia services as components of more comprehensive (or global) procedures. Bulk of Edits Pair Services With New Codes 97597, 97598 NCCI version 11.0 pairs virtually every anesthesia code with two new codes for wound debridement:

97597 - Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high-pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters

97598 - ... total wound(s) surface area greater than 20 square centimeters. The descriptors for these codes specify "without anesthesia." Procedures qualifying for these services aren't extensive enough to need anesthesia, says Scott Groudine, MD, an Albany, N.Y., anesthesiologist. If anesthesia services are necessary for the debridement, the surgeon should report more extensive codes than 97597 or 97598.
 
Note: New codes 97597 and 97598 replace 97601 (Removal of devitalized tissue from wound[s]; selective debridement, without anesthesia [e.g., high-pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session), which CPT 2005 deleted.
 
The edits involving 97597 and 97598 include too many anesthesia codes to list individually (the edits encompass all but 23 of the anesthesia codes). The exempted codes include extensive procedures such as transplantation, cardiac and some deep internal procedures that require anesthesia, says Barbara Johnson, CPC, MPC, an anesthesia coding consultant and president of Real Code Inc., in San Moreno, Calif.
 
Tip: You should still check the complete list of edits to verify whether they apply to the case you're coding before you submit your claim.
 
NCCI assigns a status indicator of "0" to these pairs, which means you cannot use a modifier to report the services separately. The single exception is 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration), which has a status indicator of "1" when paired with 97597 or 97598. This means you can report both services (01996 and either 97597 or 97598) with modifier -59 (Distinct procedural service) to differentiate the procedures and receive payment for both. Special rules apply when you unbundle codes that the edits pair, so be sure you have the correct documentation before reporting services this way.
 
"Code 01996 probably is excepted from these edits because it is a pain management code," Johnson says. "Because of this, it would be a separate service [...]