Inpatient Facility Coding & Compliance Alert

Plus, watch injection changes for pain management.

It’s that time of the year when we witness annual unveiling of new, revised, and deleted CPT^® codes for the next year. From minor wording changes to shifting whole sections, there have been a lot of significant changes in the CPT^® codes in most specialties.

“The impact of the new, revised and/or deleted CPT^® codes is highly variable depending upon the services provided by the hospital, clinics and/or physicians,” explains Duane C. Abbey, PhD, president of Abbey and Abbey Consultants, Inc., in Ames, IA. “Each year coding and billing staff must carefully review the changes and identify those that are applicable to their situation. For hospitals, a main focal point is the chargemaster for which the Chargemaster Coordinator must both assess changes and inform appropriate departments as to changes.”

Read on to be aware of how your reporting might change.

Pay Attention to Central Arterial Pressures

CPT^® 2016 will make two changes regarding codes for monitoring or assessing central arterial pressures during a patient’s surgery:

Change 1: The Category III code some practices have reported for this situation in the past – 0311T (Non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report) – will be deleted effective Jan. 1, 2016. Anesthesia guidelines only allow for invasive monitoring. Plus, some payers such as Novitas have policies indicating that 0311T is non-covered.

Change 2: You’ll have a new, more detailed code when adding this measurement to your claim: 93050 (Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform[s], digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity artery, non-invasive). Waveform analysis not only indicates central systolic and diastolic pressure, it also determines the influence of pulse wave reflection on the central pressure waveform. It can serve as a useful adjunct to brachial blood pressure measurements in initiating and monitoring hypertensive treatment and other factors.

Add More Options to Your Paravertebral Block Coding

If you code for pain management services, nerve blocks are common fare. You’ll have three new choices for paravertebral/paraspinous blocks in 2016:

• 64461 – Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)
• 64462 – … second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure)
• 64463 – … continuous infusion by catheter (includes imaging guidance, when performed).

Anticipated Changes That Did Not Occur

CPT^®’s Category III section includes a series of codes for open or percutaneous atherectomy for supra-inguinal arteries, namely 0234T-0218T. These codes were due to sunset on Jan. 1, 2016. The anticipation was that these codes would be integrated back into the regular CPT^® codes with guidance similar to sub-inguinal services. The only thing that CPT^® changed was the sunset date that has been changed to January 2021. Note that the coding, and thus the billing requirements, for these Category III codes is distinctly different from the regular atherectomy CPT^® codes.