Advanced Search

Anesthesia Coding Alert

Need More Specific Injection and Guidance Codes? CPT 2004 Has the Codes for You

Published on Thu Jan 01, 2004

CPT introduces new codes and returns to 01996

Memorizing all of CPT's anesthesia codes doesn't mean you have all of your coding bases covered. CPT 2004 includes new codes that increase injection specificity and reflect new fluoroscopic and ultrasonic guidance techniques.

Specify Injection Approach With 64449

The new CPT book includes three new injection codes - found outside the anesthesia section - that will improve coding specificity for some pain management procedures:
 

  • 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach ...). Report this new member of the somatic injection family of codes in place of 64450 (... other peripheral nerve or branch) when appropriate. Physicians would never use an anterior approach for this injection, but stating "posterior approach" makes the code more specific.
     
    The technique represented by 64449 can provide pain relief similar to an epidural and might be associated with less risk for some patients. More physicians are administering these injections for acute post-op pain management, especially following lower- extremity joint replacement. 64449 is a 12-unit code with a 10-day global period.
     
  • 64517 (Injection, anesthetic agent; superior hypogastric plexus). Physicians primarily use superior hypogastric plexus blocks to manage pelvic pain, usually cervical, testis, endometrial or colorectal pain. Some physicians use these blocks to treat radiotherapy-induced proctitis, and it may prove beneficial for diagnosing and managing chronic pelvic pain conditions. 64517 is a 10-unit block code.
     
  • 64681 (Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus). You'll appreciate having the two new codes for superior hypogastric plexus injections in CPT 2004 because physicians are administering these injections more frequently, says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C. The biggest difference between this code and 64517 is that 64681 represents permanent nerve destruction (that is, the physician injects alcohol instead of a local anesthetic for the block). 64681 is a 20-unit code.

    Add 2 Codes to Your List of Anesthesia-Related Guidance Codes

    CPT 2004 includes two new fluoroscopic and ultrasonic guidance codes that allow you to report some services more accurately:
     

  • +75998 (Fluoroscopic guidance for central venous access device placement, replacement [catheter only or complete], or removal [includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter placement] [list separately in addition to code for primary procedure]). This code covers a lot of territory, so here are the main points: The physician uses fluoroscopy to place, replace or remove a device. You cannot charge separately for the contrast injection (the hospital will probably charge for the drug itself), and the code includes all radiology supervision and interpretation related to any part of the procedure.
     
    Many anesthesiologists will include a final film - "radiographic documentation" - so other caregivers can see where the physician placed the catheter. The anesthesiologist must perform all services associated with the code before you can report it and receive reimbursement for the additional two units. You will usually only report this service in a non-hospital setting where the roles of anesthesia and radiology are sometimes less clear or in an office without a radiology department.
     
    "CPT probably added 75998 because none of the other fluoroscopy codes are directly related to central venous access placement," says Barbara Johnson, CPC, MPC, anesthesia coder with Loma Linda University Medical Anesthesiology Group in Loma Linda, Calif. "Physicians often place or replace central venous lines and access ports on a regular basis for chemotherapy patients or patients in other drug-treatment programs."
     
  • +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [list separately in addition to code for primary procedure]). Using ultrasound guidance when inserting central catheters is slowly becoming the standard of care. Many physicians use real-time ultrasound that allows better visualization of the placement but doesn't create a permanent record.    You'll need a printed ultrasound guidance record and short physician report in the patient's chart before you can report 76937. Check whether the ultrasound unit your physicians normally use can print and store data. If it can, this new code might encourage physicians to document the ultrasound exam and catheter placement in order to receive the extra unit of reimbursement.
     
    Both 75998 and 76937 are add-on codes, so be sure to  report them only in conjunction with a related procedure.

    Welcome Back 01996

    A final - and welcome - change to CPT 2004 for anesthesia coders is the reinstatement of the old descriptor and note for 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration). The accompanying note reads, "Report code 01996 for daily hospital management of continuous epidural or subarach-noid drug administration performed after insertion of an epidural or subarachnoid catheter."
     
    "Report 01996 for each day of the service," says Cindy Clark, anesthesia coding supervisor with Anesthesiology Consultants in Savannah, Ga. "Check your local carrier's guidelines for reporting the service. For example, our Medicare carrier only pays for two days of daily management; we must provide documentation of medical necessity for additional days."
     
    CPT 2003 changed this code when it added the caveat that the catheter must be placed primarily for anesthesia administration during the procedure, but retained for post-operative pain management. If the catheter wasn't used for anesthesia administration, you were to report the most appropriate E/M code for the post-op management instead. The caveat led to confusion and unmerited denials from carriers that weren't accustomed to seeing so many E/M claims from anesthesia providers.
     
    Now you can return to using 01996 for daily post-operative management, regardless of whether the physician placed the catheter to administer anesthesia or solely for postoperative care.
     
    Check each carrier's local policy on how many days you can bill 01996. Empire in New York, for example, states that "The epidural analgesia is usually employed for three days or less and may be reviewed if it exceeds this time frame."

    • Other Articles in this issue of

    Anesthesia Coding Alert

    View All