Anesthesia Coding Alert

4 critical ways to combat carrier challenges

Every coder has experienced the frustration of trying to accurately report services that don't have a specific code. This problem comes up a lot in pain management, where appropriate code choices seem to be years behind procedure techniques.

But unlisted-procedure codes don't have to mean automatic denials or write-offs. Read on for tips on how to hone your reporting strategies and boost your bottom line. Common Procedures = Common Problem CPT lacks specific codes for many common pain management procedures, including: 
  Spinal hardware injections
  IV sympathetic nerve blocks
  Ganglion impar injections
  Pulsed radiofrequency of any nerve
  Destruction of dorsal root ganglion, lumbar sympathetic nerves, SI (sacroiliac) joint nerves. When you don't have a specific code, you typically report 64999 (Unlisted procedure, nervous system). But you have other options. Other codes with potential pain management use include 22899 (Unlisted procedure, spine) and 27299 (Unlisted procedure, pelvis or hip joint), says Marvel J. Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver.

Note: One procedure that recently dropped off the unlisted-procedure-code list is intradiskal electrothermal therapy (IDET). CPT Codes introduced a Category III code for IDET effective July 1, 2004 (0027T, Endoscopic lysis of epidural adhesions with direct visualization using mechanical means [e.g., spinal endoscopic catheter system] or solution injection [normal saline] including radiologic localization and epidurography). Once CPT includes a Category III code, you must report it for the procedure (instead of an unlisted-procedure code) unless a carrier specifically states it is incapable of processing Category III codes. 'Close' Doesn't Count in Coding Many coders try to avoid reporting "unlisted-procedure" codes such as 64999 because they don't adequately describe the procedure in question. Because of this, some coders reported codes that were close to the procedure performed instead of the appropriate section's unlisted-procedure code. That's not a good habit to acquire, for a number of reasons.

Fraud alert: The primary reason this is inappropriate is because of potential fraud. "Selecting a code that is 'close' is not compliant coding," Hammer says. "Knowingly and willingly coding a service or procedure with a code for the explicit motivation of bypassing denials and ensuring payment is fraud. The documentation will not support the procedure being billed."

"It's never appropriate to choose a code that is close but doesn't really fit the procedure," agrees Gina Graham, CPC, an anesthesia and pain management coder in Hepzibah, Ga. "One way that the American Medical Association (AMA) tracks the need for new codes is through the unlisted procedures that are reported. At some [...]