LCDs and other resources to help you determine when 01996 is legit.The descriptor for 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) seems simple enough on the surface, but can get complicated in real-life coding. Read on for three scenarios from the Coding 911 listserv and our experts’ answers on how to handle each situation. Global Periods Help Steer Your 01996 Usage Scenario 1: Our physician recently inserted an intrathecal pump, which [...]
News Flash: Modifier AA Could Bring You Extra Pay for CAH Services in 2012 (November 2011)
Check the updated guidelines if you bill anesthesia services on behalf of a critical access hospital.If you bill anesthesia services on behalf of the provider through a Method II critical access hospital (CAH), your bottom line could improve starting in January 2012. Background: Anesthesiologists who provide services in a Method II CAH (sometimes referred to as CAHs that have elected the “optional” method) have the option of reassigning their billing rights to the CAH. The [...]
ICD-10: New K38 Choices Will Expand Appendicitis Specificity (November 2011)
Watch for ‘other’ versus ‘unspecified’ options.When your anesthesiologist participates in an appendix surgery, you’ll have more specific diagnosis code choices for appendix removal under ICD-10, effective Oct. 1, 2013. Separate ‘Other’ From ‘Unspecified’ Coding for acute appendicitis will change as follows, from ICD-9 to ICD-10:540.0 – Acute appendicitis with generalized peritonitis becomes K35.2 with an identical definition 540.1 – Acute appendicitis with peritoneal abscess becomes K35.3 (Acute appendicitis with localized peritonitis)540.9 – Acute appendicitis without peritonitis leads to [...]
You Be the Coder: Deciding Time Between CRNA and Anesthesiologist (November 2011)
Question: A non-medically directed CRNA took the patient into the operating room. He placed the patient on monitors, intubated, and induced the patient. Then the anesthesiologist came into the room and placed an arterial line and CVP before the case started. How do we calculate the time the physician took to place the lines?New Mexico Subscriber Answer: Deduct the time spent placing the arterial line and CVP from the total anesthesia time, and bill the [...]
Reader Question: Only Report 20610 With 27093 in Special Circumstances (November 2011)
Question: Our pain management physician sometimes performs a hip arthrogram and hip injection during the same patient encounter. Can we bill both services? Vermont Subscriber Answer: The codes in question include 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]), 27093 (Injection procedure for hip arthrography; without anesthesia), and 73525 (Radiologic examination, hip, arthrography, radiological supervision and interpretation). Current CCI edits list 20610 as a Column 2 code [...]
Reader Question: Include AD for Maxed Concurrent Cases (November 2011)
Question: What are the current Medicare rules when our anesthesiologist bills more than four concurrent cases? Do we reduce the units, or does Medicare?South Carolina Subscriber Answer: Always include modifier AD (Medical supervision by a physician; more than 4 concurrent anesthesia procedures) with each claim when the anesthesiologist reports more than four concurrent cases. Units drop: Carriers may allow only three base units per procedure when the anesthesiologist is involved in more than four procedures [...]
Reader Question: Patient’s Position Determines 01991 or 01992 (November 2011)
Question: Our anesthesiologist sometimes performs anesthesia for a pain management physician. In a recent procedure, the pain management specialist performed 64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level) and +64627 (… cervical or thoracic, each additional level [List separately in addition to code for primary procedure]). How should I code our anesthesiologist’s involvement?North Dakota Subscriber Answer: The anesthesia codes correspond to the patient’s position at the time of the [...]
Reader Question: Placement Clues You to Central Line With Swan-Ganz (November 2011)
Question: Our anesthesiologist recently documented that we should code for a central line, arterial line, and Swan-Ganz catheter during a procedure. It’s been a long time since one of our physicians marked all three for a single case; what’s the current rule regarding line coding?Mississippi Subscriber Answer: You can bill the arterial line with 36620 (Arterial catheterization or cannulation for sampling, monitoring, or transfusion [separate procedure]; percutaneous). The central line (36556, Insertion of non-tunneled centrally [...]
Reader Question: Keep 64612 or 64613 to Single Unit, Not Bilateral (November 2011)
Question: When our physicians administer Botox for chronic migraines, we bill the HCPCS J code for the drug with procedure code 64613 and modifier 50. Payers are sending multiple denials, stating that the procedure/modifier combination is invalid. What’s our best coding strategy? Texas Subscriber Answer: When billing injections of Botulinum toxins, aka chemodenervation, the key is to review the CPT® code terminology. The procedure code you’ll turn to is 64613 (Chemodenervation of muscle[s]; neck muscle[s] [...]
Reader Question: Intent Helps Distinguish SI Injection From Arthrogram (November 2011)
Question: What is the difference between a sacroiliac (SI) joint injection and an SI joint arthrogram? How do I know the difference when requesting authorization prior to the procedure being rendered?South Carolina SubscriberAnswer: An arthrogram requires a formal radiological interpretation and report that the physician uses for further diagnosis and treatment of the patient. It also requires that hard copies of multiple views of the arthrogram be obtained. In contrast, the fluoroscopic guidance used with [...]
