The Coding Institute Anesthesia & Pain …

1 Your practical adviser for ethically optimizing Coding , payment, and efficiency in Anesthesia and pain management practicesAnesthesia & pain ManagementCoding Alert2009, Vol. 11, No. 12 (Pages 89-96) Anesthesia & pain ManagementCoding AlertCapture TPIs With Injections and More, Thanksto Edit Reversals XCCI zeroes in on moderate sedation, but allows formore unbundling. The latest Correct Coding Initiative (CCI) edits delete previous CCI edits for manyacute postoperative pain management codes, and change modifier indicators for some ofthe most common pain management procedures. CCI went into effect Oct. 1 andincludes thousands of new, swapped, and terminated code pairs you need to implementnow in order to file the correct codes and get reimbursed In to Modifier Indicator Changes With Biggest Impact The big changes for Anesthesia and pain management involve the change from a 0 modifier indicator to a 1 modifier indicator, says Marvel J.

2 Hammer, RN, CPC,CCS-P, PCS, ACS-PM, CHCO,owner of MJH Consulting in Denver. Having a 1 modifier indicator means you can append a modifier and bypass the bundling edits, thusgaining clearance to report both procedures. Example:CCI lists trigger point injections 20552 (Injection[s]; single ormultiple trigger point[s], 1 or 2 muscle[s]) and 20553 (.. single or multiple triggerpoint[s], 3 or more muscle[s]) as Column 1 codes. Now you can append modifiers tobypass the edits for trigger point injections and Column 2 codes representing some ofyour most common procedures: 62310 Injection, single (not via indwelling catheter), not including neurolyticsubstances, with or without contrast (for either localization or epidurography), ofdiagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid,steroid, other solution) epidural or subarachnoid; cervical or thoracic 62311.

3 Lumbar, sacral (caudal) 64408 Injection, anesthetic agent; vagus nerve 64410 .. phrenic nerve 64435 .. paracervical (uterine) nerve. Faster filing: One important reminder is that the modifier must be appended to theColumn 2 code and not the lower relative value unit (RVU) code, Hammer says. In theexample above, the trigger point injection codes carry a lower RVU. If you append themodifier to the Column 1 code instead of the Column 2, however, the carrier will denyyour claim. The change is retroactive back to April 1, 2009. The Coding InstituteWhat s InsideCurb Your Excitement OverTerminated Edits ..91 XMost CCI deletions applyto non-covered You Can Use: ImplementYour Swan-Ganz Boost.

4 92 XUpdated MPFS includes payhike for catheter Moderate SedationCoding With These Easy Steps ..92 XCCI will have youwatching provider involvementand Be the Coder ..92 XLearn Crosswalks forEndoscopy ProceduresReader QuestionsStudy E/M Definitions With 01992 Depends 1 Level for 2 MedialBranch Nerve Hysteroscopy Crossesto These Examples for PModifier Lumbar NerveDecompression ..95 Report J1885, 93672 for pairs with modifier indicator changes involveColumn 1 codes 27096 (Injection procedure for sacroiliacjoint, arthrography and/or anesthetic/steroid), 36557(Insertion of tunneled centrally inserted central venouscatheter, without subcutaneous port or pump; youngerthan 5 years of age), 36558 (.)

5 Age 5 years or older), and36560-36566 (Insertion of tunneled centrally insertedcentral venous access device ..). All the modifier indicator changes are retroactive toApril 1, Your Moderate Sedation OpportunitiesCCI includes 18,320 new edit pairs, according toa summary report by Frank Cohen, PA,of MIT SolutionsInc. in Clearwater, Fla. The overwhelming majority havea modifier indicator of 0, meaning you cannot use amodifier even if you think it is appropriate, Cohen statedin a press most common codes being paired in new edits arefor some moderate sedation services: 99148 Moderate sedation services (other thanthose services described by codes 00100-01999),provided by a physician other than the health careprofessional performing the diagnostic or therapeuticservice that the sedation supports; younger than 5years of age, first 30 minutes intra-service time 99149.

6 Age 5 years or older, first 30 minutesintra-service time +99150 .. each additional 15 minutes intra-service time (List separately in addition to code forprimary service). Note that the majority of the new edits were formoderate sedation performed by another physician insteadof the performing surgeon, Hammer says. These newbundling edits make sense that the physician reporting thesurgical procedure code should not be able to report theseparticular moderate sedation codes that require a differentprovider performing the moderate sedation services. pain practices:Anesthesiologists provide anesthesiaduring procedures, not moderate sedation which meansyou wouldn t be reporting 99148-99150 anyway.

7 Butyou re in a different situation when Coding pain manage-ment. Your pain management specialist becomes the surgeon when administering injections, so you mighthave reported moderate sedation for some procedures inthe past. Switch the Codes in These Pairs As if keeping up with new edits isn t tricky enough, asan Anesthesia or pain management coder you also have swapped edit pairs to change in your system. Page 90 Get CPC certified in 4 days 2009, Vol. 11, No. 12/ Anesthesia & pain management Coding alert Anesthesia & pain management Coding alert (print ISSN 1533-590X, online ISSN 1947-8704) (USPS # 019-444) is publishedmonthly by The Coding Institute , a subsidiary of Eli Research, 2222 Sedwick Road, Durham, NC 27713.

8 2009 The Coding rights reserved. Subscription price is $397. Periodicals postage is paid at Durham, NC, 27705 and additional entry : Send address changes to Anesthesia & pain management Coding AlertPO Box 413006, Naples, FL Customer Discussion Rates: USA: 1 yr. $397; 2 yrs. $774 (save $20), 3 yrs. $1141 (save $50).Bulk prices available upon request. Credit Cards Accepted: Visa, MasterCard, American Express, DiscoverCPT codes, descriptions, and material only are copyright 2009 American Medical Association. All Rights Reserved. No feeschedules, basic units, relative values, or related listings are included in CPT.

9 The AMA assumes no liability for the data containedherein. Applicable FARS/DFARS Restrictions Apply to Government & pain management Coding Alertis independent and not affiliated with any organization, HMO, vendor, orcompany. Reasonable attempts have been made to provide accuracy in the content. Of necessity, however, examples cited andadvice given in a national periodical such as this must be general in nature and may not apply to any particular case. Further,medical Coding is part science, part art; even experts sometimes differ. Also, clinical and other circumstances may differ betweencases and thereby affect Coding . Thus, neither the publisher, editors, board members, contributors, nor consultants warrant orguarantee the information contained herein on Coding or compliance will be applicable or appropriate in any particular information tailored to your specific circumstances, consult a qualified information on copyright violations?

10 Call us! We ll share with you 25% of the net proceeds of all awards related tocopyright infringement that you bring to our attention. Contact Samantha Saldukas at (239) 280-2301, fax (239) 790-3803, or e-mail publication has the prior approval of the American Academy of Professional Coders for ContinuingEducation Units. Granting of this approval in no way constitutes endorsement by the Academy of the content. Call The Coding Institute at (800) 508-2582 for more information about how to receive your CEUs. CONTACT INFORMATIONWe would love to hear from you. Please send yourcomments, questions, tips, cases and suggestionsfor articles related to Anesthesia and painmanagement Coding , reimbursement, or complianceto Leigh DeLozier, CPC, at Box 413006, Naples, FL 34101-3006 Phone:(800) 508-2582 Fax:(800) 508-2592 Editor:Leigh DeLozier, Editors:Scott Groudine, MDMarvel Hammer,RN, CPC, CCS-P, ACS-PM, CHCOM anaging Editor:Mary Compton, PhD, CPC Publisher:Jeanne Caggiano of Development:Bridgett Hurley, JD, Gardiner of Sales:Bill Streight Group Manager:Bret Brockbank Conference Manager:Mariangela Director.