Anesthesia Coding Alert

Treatment stage, modifiers and other services matter Last month, we discussed the importance of having a referral for treatment, ensuring medical necessity and coding all parts of the actual procedure for spinal injections. But don't stop there! Make a big difference in your bottom line by knowing the patient's treatment stage, when to separately report a corresponding E/M service, and when you can charge for multiple pain procedures. Know the Patient's Treatment Stage Patients rarely have a single epidural steroid injection (ESI) without follow-up injections, so you need to know what stage of the process the patient is in when you're coding. If an initial injection works well, the follow-ups will maximize this effect. If the initial injection works poorly, the physician will often attempt a second injection before abandoning this treatment approach.
 
"The first visit includes a review of systems (ROS), physical exam and medical history," says Terry Garcia, a coder with Tejas Anesthesia in San Antonio. "Then the doctor determines whether the patient would benefit from the injection. On follow-up visits, the doctor evaluates the patient to check whether he or she has improved. The physician administers the second treatment injection and determines whether a third visit is necessary."
 
A physician typically administers one ESI per session, unless the patient also has lumbar and cervical pain. Then the physician administers one injection per site for each visit. You report the same codes (62310 or 62311) as for the initial ESI and file each visit on a separate claim. Timing Is Everything Timing the sessions depends on the exact procedure and how well the patient responds (it can take one or two days after the injection to know whether it worked). The physician can administer an ESI as a single injection or in a series, but Robin Fuqua, CPIC, a coder for Jose Feliz, MD, in Escondido, Calif., says they are usually most effective in a series of three injections spaced two weeks apart. If the first two injections don't help, the physician doesn't typically administer a third.
 
"Some patients get such significant relief from the initial injection that they wait several months before having another," says Tammy Reed, anesthesia department billing manager for Oklahoma University Health Science Center in Oklahoma City. "Other patients go through a series of injections in order to reach the maximum amount of pain relief. Some patients don't get relief from the ESI and don't repeat the injections."
 
Patients who don't get relief from ESIs might be candidates for other procedures such as implanting a continuous infusion pump or implanting electrodes.
 
Whatever stage of the process the patient is in, you can report a separate code for an E/M visit if the physician administers the injection in an outpatient [...]