A U.S. based medical billing outsourcing company with extensive experience; Outsource Strategies International (OSI) provides anesthesiology medical billing services with expert coders and billing specialists on board and can help providers stay current with changes, submit accurate claims, and optimize reimbursement.

In today’s podcast, Meghann Drella, one of our Senior Solutions Managers, discusses about key coding and billing changes impacting anesthesiology in 2020

In This Episode

00:14 An introduction to changes in codes and billing requirements in the anesthesia specialty

Each year there are code additions, deletions and revisions and new reporting guidelines impacting anesthesiologists.

00:25 Changes apply to anesthesia practices in 2020

There's some important changes applied to anesthesia practices in 2020, which includes changes in:

  • 00:31 - Amended Intercostal Nerve Block Codes
  • 01: 27 - Nerve Block Code Definition Amended To Permitsteroid Injections
  • 01:40 - Clarifications On Imaging Guidance
  • 02: 25 - Deleted Nerve Blocks
  • 02:42 - New Genicular And Sacroiliac Codes

04: 28 Medicare national conversion factor (CF)

The 2020 Medicare National CF for anesthesia decreased when the 2020 CF for surgical services increased slightly.

Hello and Welcome to our Podcast Series. My name is Meghann Drella and I am a Senior Solutions manager here at Outsource Strategies International. Today I will be discussing key coding and billing changes impacting anesthesiology in 2020

Each year brings about expectations of changes in codes and billing requirements in the anesthesia specialty. Our last update looked at anesthesia coding and reporting guidelines for 2019.

Let’s take a look at important changes that apply to anesthesia practices in 2020:

  • There's an Amended Intercostal Nerve Block Codes: Intercostal codes are used for acute post-surgical pain relief. The changes to the CPT codes for intercostal nerve block codes include deletions as well as revisions and additions.

In 2019, either code 64420 or 64421 was used, not both. In 2020, blocking multiple levels will require coding both 64420 and 64421.

Key points to note are that

  • The parent code for somatic nerve injections was revised by adding to clarify that multiple injections are included in the codes.
  • 64421 is now an add-on code
  • One unit of 64421 can be coded for each additional intercostal nerve block done in excess of the initial level
  • The right and left modifiers can be appended as 64421 is an add-on code
  • Modifier 50 can be appended to the primary code, 64420, where applicable.
  • Nerve Block Code Definition Amended To Permitsteroid Injections: The descriptors of nerve block codes 64400-64450 have also been changed to include steroid injections.
  • There's also Clarifications On Imaging Guidance:  CPT guidelines also distinguish between codes for which image guidance is included and for which it can be separately reported.
    • Codes 64400-64450 do not include/bundle imaging guidance. So providers can bill imaging such as ultrasound guidance separately when performed and documented with this particular code set.
    • Imaging guidance is included in the codes for transforaminal epidural injections, paravertebral blocks and TAP blocks.
    • Imaging guidance is also an inherent component of the new codes for 2020 to describe genicular and sacroiliac injections and destruction. CPT’s instructional guidance explains the number of units that can be billed for each code and if imaging guidance is included in the code descriptor.
  • There's some Deleted Nerve Blocks: The following three nerve blocks were deleted in 2020 since they are rarely performed: 64402, 64410 and 64413. CPT instructs that the unlisted code 64499 should be reported if these are performed.
  • New Genicular And Sacroiliac Codes: New genicular and sacroiliac codes became effective January 2020. Here are the 4 new codes and instructions for their use as listed by the American Academy of Pain Medicine:
    • 64451: If performed using ultrasonic guidance, the unlisted code 76999 should be reported. These services should not be reported in conjunction with codes that describe paravertebral facet joint injections, radiological guidance or guidance codes for chemodenervation. Modifier 50 should be appended when performed bilaterally.
  • 64625: Radiofrequency ablation, nerves innervating the sacroiliac joint, with imaging guidance.

So do not report 64625 with destruction of lumbar or sacral facet joint, radiological guidance or guidance codes for chemodenervation. Code 64625 can be reported with modifier 50 when bilateral procedures are performed.

  • 64454: Anesthetic agent and/or steroid; genicular nerve branches, including imaging guidance when performed.

This code requires injection of all nerve branches to include superolateral, superomedial, and inferomedial. If all three nerve branches are not injected, then modifier 52 should be appended to code 64454. Only one unit of service should be reported.

  • 64624: Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed.

Code 64624 requires destruction of three genicular nerve branches, includes imaging guidance, and should only be reported with one unit of service. Do not report this code in conjunction with the injection code 64451. Modifier 52 should be appended if all nerve branches are not destroyed.

The 2020 Medicare national conversion factor (CF) for anesthesia decreased when the 2020 CF for surgical services increased slightly. Several nerve block codes were revalued for 2020, reflecting an overall reduction in payment.

It is important that anesthesiologists take note of these changes and avoid denials and/or payer scrutiny.

I hope this helps, but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursements for the procedures performed.

Thank you for joining me and stay tuned for my next podcast.