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Anesthesia Coding Alert

Optimize Reimbursement for Tricky New Pain Management Codes

Although a new system of pain management codes has been in effect for more than a month now, anesthesia coders still are having problems adjusting to the new codes (see CPT 2000 Changes for Anesthesia Practices, Anesthesia Coding Alert, December 1999). According to L. Charles Novak, MD, an anesthesiologist in Wenatchee, Wash., and chair of the American Society of Anesthesiologists (ASA) committee on economics, and Stanley W. Stead, MD, professor and vice chair of anesthesiology at UCLA Healthcare and the ASAs representative to the CPT Advisory Panel, there are ways to cut through the confusion. Pairing the new codes with other procedure codes and the appropriate modifiers will gain reimbursement for anesthesiologists, they claim.

The changes are dramatic and affect every anesthesia group that provides pain management services, says Novak. Changes to the pain codes are described below. This information may be used as a general guide, but refer to CPT 2000 for complete descriptors of each code.

1. New Codes for Subarachnoid and Epidural Injections: The largest group of new pain codesthere are 16deals with administering subarachnoid and epidural injections. These are codes 62310-62319, codes 64470-64484, and codes 62263, 64626, 62627 and 27096. They fall under two procedure groups:

Spinal and epidural injections (not involving neurolytic substances) for both single-shot and continuous techniques. The generic descriptor includes needle and catheter placement, the injection of contrast material, and injection of any agent that is not neurolytic. More specific codes within the group divide services between single-shot and continuous treatment and distinguish between various levels of approach.

Percutaneous lysis of epidural adhesions (with or without endoscopic guidance) Code 62263 covers the use of hypertonic saline, enzyme or mechanical techniques for lysis.

Most of these codes are self-explanatory and stand on their own. However, codes 62318 and 62319 (which deal with injections with or without contrast of a diagnostic or therapeutic substance to either the cervical/thoracic or lumbar/sacral area) must be reported along with code 01996 to report daily management of epidural or subarachnoid drug administration.

Code 62263 (percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., spring-wound catheter] including radiologic localization [includes contrast when administered]) requires epidural contrast injection for analysis of the epidural space prior to the injection of the neurolytic agent. Therefore, code 72275 (epidurography, radiological supervision and interpretation) also should be reported to describe the work involved.

2. New radiological codes: Three new radiological codes were added to CPT 2000. They are:

76005 (fluoroscopic guidance and localization of
needle or catheter tip for spine or paraspinous
diagnostic or therapeutic injection procedures
[epidural, transforaminal epidural, subarachnoid,
paravertebral facet joint, paravertebral facet joint nerve or [...]