Medicare Compliance & Reimbursement

Transfer of care has a new definition to check how sick the patient was at the time of transfer.

There aren’t any new Category I codes for anesthesia providers in CPT^® 2014. However, there are some additions and revisions to the Category II section. Get all the details from anesthesia coding expert Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

Two New Measures Look at Patient Transfers

You’ll find two new Category II codes describing how the patient is transferred from the treatment location to the critical care unit:

• 0581F — Patient transferred directly from anesthetizing location to critical care unit (Peri2).
• 0582F — Patient not transferred directly from anesthetizing location to critical care unit (Peri).

“These appear to be a new PQRS measure for anesthesia,” Dennis says. “Since the anesthesia provider transfers the patient to either the post-anesthesia care unit (PACU) or the crucial care unit (CCU), these PQRS codes will track how sick the patient was upon transfer of care.”

Note: Although the codes technically were implemented on Jan. 1, 2013, they were not added to the PQRS anesthesia measurement codes at that time. Current information shows that these “performance measurement” codes will be introduced in CPT^® 2014.

Four Codes Change Anesthesia Measure 193

Dennis says that four new Category II codes appear to be a change to the current PQRS measure 193 for anesthesia (Perioperative temperature management). The new codes are:

• 4553F — Patient received inhalation anesthetic agent (Peri2).
• 4555F — Patient did not receive inhalation anesthetic agent (Peri2).
• 4559F – At least 1 body temperature measurement equal to or greater than 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (Peri2).
• 4560F — Anesthesia technique did not involve general or neuraxial anesthesia (Peri2).

Possible confusion: You currently report postoperative temperature management with performance measurement codes 4250F-4256F. However, these codes apparently still will be effective in 2014 — and they’re very similar to the new codes listed above.

“I don’t understand why this data would be collected and reported when it’s so close to measure 193,” Dennis says. “We can only hope to get further clarification so we’ll report things accurately. Also, make sure your coding staff checks anesthesia PQRS updates on an annual basis!”

Be Aware of Hypothermia Code Shifts

Two Category III (temporary) hypothermia codes that were introduced in 2012 will move to Category I status next year:

• Temporary code 0260T (Total body systemic hypothermia, per day, in the neonate 28 days of age or younger) will become +99481 (Total body systemic hypothermia in a crucially ill neonate per day [List separately in addition to code for primary procedure]).
• Temporary code 0261T (Selective head hypothermia, per day, in the neonate 28 days of age or younger) will become +99482 (Selective head hypothermia in a critically ill neonate per day [List separately in addition to code for primary procedure]).

Caution: The codes represent controlled hypothermia, but they aren’t intended for anesthesia providers. “Remember, we use qualifying circumstances codes for hypothermia unless it’s already included in the base value of the anesthesia code,” Dennis says.

Example 1: Certain anesthesia codes include hypothermia as part of the service, such as 00561 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age) and 00563 (... with pump oxygenator with hypothermic circulatory arrest). The mention of a pump oxygenator and hypothermic circulatory arrest are your clues that hypothermia is inherent in the procedure, so additional codes for the service aren’t necessary.

Example 2: If your provider induces hypothermia when it isn’t inherent to the anesthesia service, you can include +99116 (Anesthesia complicated by utilization of total body hypothermia [List separately in addition to code for primary anesthesia procedure]) on the claim. Being able to report +99116 is always good news for your bottom line because it adds a whopping 5 base units to your total, due to the higher level of work demanded of your anesthesiologist.