Anesthesia Coding Alert

When the Correct Coding Initiative (CCI) edits (7.2) took effect in July, codes related to anesthesia services were not greatly affected, but pain management codes were.
 
"Many codes used by interventional pain management physicians are now bundled into comprehensive codes," says Patricia Bukauskas, CMM, CPC, a pain management coding and reimbursement specialist in Aliquippa, Pa. "There are also several other general changes to be aware of."
 
With so many revisions to component and mutually exclusive codes, Bukauskas advises coders to watch these areas closely. Component codes are included in services designated by broader-scope comprehensive codes; mutually exclusive codes are for services that cannot be performed in the same session.
 
Note: An update on changes to mutually exclusive codes will be in the October issue of Anesthesia and Pain Management Coding Alert.
General Changes for Epidurals and Injections  
Some codes for nerve blocks or other injections can no longer be used with fluoroscopy codes 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034), 76001 (fluoroscopy, physician time more than one hour, assisting a non-radiologic physician), 76003 (fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) and 76005 (fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction). "This is one area where pain management specialists have been able to bill an additional code for services and increase their reimbursement," says Barbara Johnson, CPC, MCP, professional coder with the physician group Loma Linda University Anesthesiology Medical Group Inc. in Loma Linda, Calif. "This new exclusion will decrease reimbursement greatly." 
 
Epidural procedures performed in the same region cannot be combined, including lysis, interlaminar, caudal and transforaminal epidurals. Although physicians at Loma Linda do not commonly administer multiple epidurals in the same area, Johnson says physicians at other facilities who may have done it before will no longer be able to.
 
Nerve blocks and neurolytic blocks performed in the same region cannot be combined. For example, if a physician administers local anesthesia through a needle as a test and achieves pain relief for the patient, he or she might then inject alcohol or another neurolytic agent. Rather than billing a local and neurolytic block, only the neurolytic block should be billed, and will be paid as a comprehensive procedure.
 
Epidurals can no longer be billed with diskograms. Diskography, 62290* (injection procedure for diskography, each level; lumbar), now includes injection codes 62311, 62319, 64479 and 64483. Three [...]