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Billing and Coding Changes that Matter to Anesthesiologists in 2017

by | Jun 22, 2017 | Medical Coding News, Resources | 0 comments

The practice of anesthesiology is facing certain coding and reimbursement changes in 2017. Anesthesiology medical billing companies, surgeons, chronic pain practices and other specialists need to pay close attention to the latest advances, guidelines, and specific recommendations, and incorporate them into practice.

The most significant anesthesia medical billing and coding changes in 2017 are as follows:

CPT Code Changes for Epidural Steroid Injections (ESI): Four codes were deleted and replaced with the 8 new codes in order to identify whether or not imaging guidance has been used for each type of injection and anatomic area. The medical coding changes are the outcome of a CMS (Centers for Medicare and Medicaid Services) screen which recognized a likelihood of misvalued services pertaining to the Medicare Physician Fee Schedule.

Additions

  • 62320 Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
  • 62321 Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (i.e., fluoroscopy or CT)
  • 62322 Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
  • 62323 Injection (s) of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution) not including neurolytic substances including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (i.e., fluoroscopy or CT)
  • 62324 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
  • 62325 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (i.e., fluoroscopy or CT)
  • 62326 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
  • 62327 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (i.e., fluoroscopy or CT)

Deletions

  • 62310 Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic
  • 62311 Injection(s), of diagnostic or therapeutic substance(s)… lumbar or sacral (caudal)
  • 62318 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic
  • 62319 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s)… lumbar or sacral (caudal)

Changes in Moderate Conscious Reporting

In 2017, any service less than 10 minutes in duration is not reported separately. Billing for moderate (Conscious) Sedation is based on the intra-service time, which starts with the administration of the sedation agent(s), requires continuous face-to-face attendance, and ends at the conclusion of personal contact by the physician or Qualified Health Care Professional (QHCP).

The following codes have been deleted:

  • Deleted: 99143, 99144, and 99145 – moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service and further specified by age of patient and intraservice time.
  • Deleted: 99148, 99149, and 99150 – moderate sedation provided by a physician or other qualified healthcare professional other than the physician performing the procedure
  • Added: 99151, 99152, and 99153 replaced 99143-99145. The intraservice time has decreased from the initial 30 minutes to 15. Additional intraservice time increments remain at 15
  • Added: 99155, 99156, and 99157 replaced 99148-99150 – The intraservice time decreased to an initial 15 minutes from 30

Note: If moderate sedation is performed by the second physician in a non-facility setting such as a physician’s office or a freestanding imaging center, codes 99155-99157 are not reported.

CPT Guideline Updates

  • The addition of a new parenthetical comment for code 01992 indicates that moderate sedation should not be billed with 01991 or 01992 (anesthesia for chronic pain injections). Moderate sedation codes and anesthesia codes are mutually exclusive; either can be billed, but not both.
  • If a procedure is performed in the facility and moderate sedation is performed by a physician other than the physician performing the procedure, the physician performing moderate sedation can only bill 99155-57. This means that those codes are not billable in the office setting (the theory is that a second physician is not medically necessary in the office; and, if a second physician is needed for moderate sedation, the procedure should be performed in a facility).
  • Moderate sedation is not Monitored Anesthesia Care (MAC) or deep sedation.

Some ASA Crosswalk Changes

Though there is no change in the surgical procedure code from 2016, the ASA has changed the anesthesia code to which that procedure crosses in 2017.

  • Pacemaker – Insertion of Leads or Catheters: From the pacemaker code, 00530/4 units in 2016, the insertion or replacement of pacemaker electrodes or pacing catheters have crossed to the central venous access code 00532/4 units.
  • Pacemaker – Removal of Leads or Catheters: Likewise, the removal of pacemaker electrodes or pacing catheters which crossed to the code for closed chest procedures, 00520/6 units in 2016, crossed to the integumentary code, 00400/3 units this year.
  • Transabdominal Amnioinfusion; Fetal Umbilical Occlusion; Fetal Fluid Drainage: Though they did not cross to an anesthesia code in 2016, these 3 procedures are reflected by the code for lower abdomen procedures, 00840/6 units, in 2017.
  • CT Guidance – Localization, Needle Placement, and Monitoring of Radiation Therapy and Parenchymal Tissue Ablation: Beginning 2017, these procedures crossed to the non-invasive imaging or radiation therapy code, 01922/7 units, though they did not fall under any anesthesia codes in 2016.
  • Otoacoustic Emissions – Comprehensive or Limited. While the otoacoustic emissions procedures did not have an anesthesia cross-code in 2016, they crossed to the integumentary system code, 00300/5 units, in 2017.

Fluoroscopy Updates

  • Codes 77002 and 77003 are now add-ons: Two fluoroscopy codes have been designated “add-on” codes in 2017:
    • 77002, Fluoroscopic guidance for needle placement (e.g. , biopsy, aspiration, injection, localization device) (list separately in addition to code for primary procedure), and
    • 77003, Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (list separately in addition to code for primary procedure),

    77002 and 77003 no longer “stand alone” as an independently billed service and may be reported only in addition to designated primary codes. The injections include imaging guidance, when provided. According to a new guideline, 77003 should not be reported in conjunction with injection codes: 62320, 62321, 62322, 62323, 62324, 62325, 62326, and 62327.

  • Global Periods: The services represented by codes 77001-77003 now have the same global period as the underlying procedure.
  • Interlaminar Epidurals: Unlike last year, interlaminar epidurals cannot be billed with 77003 in 2017. The reason is that the use of fluoroscopy with interlaminar epidurals is built into the new epidural codes.

Anesthesia Issues in the 2017 HHS OIG Work Plan

The two issues listed in the 2017 OIG Work Plan are:

  • The OIG will review Medicare Part B claims for anesthesia services to determine whether they were met Medicare requirements, specifically to determine whether the beneficiary had a related Medicare service.
  • Physicians must report the appropriate anesthesia modifier code to communicate whether the service was personally performed or medically directed. Service code “AA” modifier is used for anesthesia services personally performed by an anesthesiologist. The “QK” modifier is used for medical direction of two, three, or four concurrent anesthesia procedures by an anesthesiologist, and limits payment to 50 percent of the Medicare allowed amount for personally performed services claimed with the AA modifier. The OIG will determine whether Medicare payments for anesthesiologist services reported on a claim with the “AA” service code modifier met Medicare requirements.

Practices should be up to date with medical coding information. All anesthesia records should include documentation of the patient’s physical status and any co-morbidities as this information helps support the medical necessity for anesthesia.

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