Anesthesia coding is rife with complex rules and tough-to navigate definitions. That’s why it’s important to keep your skills sharp and up to date—especially during this season of new codes: 2019 ICD-10 took effect October 1, 2018, and updates to the Current Procedural Terminology (CPT®) code set take effect on January 1, 2019.
In her 4-part anesthesiology coding series — as part of the 2019 Coding Updates Virtual Boot Camp — coding consultant Kelly Dennis walks you through the trickiest parts of anesthesiology coding for 2019. She explains how to cope with significant changes, code for advanced procedures, audit your own billing practices—and understand the differences among CPT®, RVG®, and HCPCS anesthesia modifiers.
Here’s a brief guide to begin your 2019 preparations:
2 Code Deletions + New Anesthesia Guidelines
For 2019, there aren’t any new anesthesia-specific CPT® codes. So you don’t have as much new information to memorize as you did last year, but that also means it’s time to follow up on 2018 changes and finally resolve issues that have been confusing you for a while.
New: And do be sure to review the CPT® Anesthesia Guidelines, which have been updated to clarify unlisted procedures. Fortunately, these updates make the guidelines more consistent with information found elsewhere.
Plus: There are two CPT® deletions for 2019:
- 64508, Injection, anesthetic agent; carotid sinus (separate procedure)
- 64550, Application of surface (transcutaneous) neurostimulator.
Also, you’ll want to watch out for changes to pain management codes and definitions. As you know, imaging is bundled into quite a few pain procedures, and imaging guidelines have changed for 2019 as well.
Example: Be sure to follow new guidance when coding for procedures such as interlaminar epidurals (62321, 62323, 62325, 62327), TAP blocks (64486-64489), or facet joint ablation (64633-64636).
Nail Down Your Grasp of 2018 Changes
The 2018 code changes introduced quite a few deletions. Here’s a reminder of the codes you should have removed from your toolbox this year. These changes deal mainly with gastrointestinal (GI) issues:
- 00740 (X) was deleted and replaced by 00731 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodendum; not otherwise specified) and 00732, a code for endoscopic retrograde cholangiopancreatography (ERCP).
- 00810 was deleted and replaced by 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodendum; not otherwise specified) and 00812, a code specifiying screening colonoscopy. Remember to use 00812 for all screening colonoscopies, regardless of resulting findings.
- A new code forprocedures involving both upper and lower endoscopy was added: 00813, Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodendum.
- Codes 01180, 01190, and 01682, all relating to obdurator neurectomy, were deleted due to low utilization.
CPT vs. RVG
Of course, your bottom line as a coder is and will always be getting paid. Although it’s surely been drilled into your head by now, be sure to properly follow rules from all payers—both private and Medicare/Medicaid. Not every insurer follows CPT® guidelines. You must always show medical necessity to be properly reimbursed.
It’s a good idea to review the Relative Value Guide (RVG®), which contains all the latest CPT® codes, as well as full descriptors for anesthesia services, the base value units as defined by the American Society of Anesthesiologists (ASA), and other information pertinent to anesthesia services, coding, and billing. To get the most out of your coding practice, take advantage of the RVG®, especially when you’re unsure about a certain CPT® code or set of codes.
Don’t Undervalue Services
Accuracy in anesthesia coding is especially vital as any error can undervalue your anesthesia services, which ultimately leads to lost revenue. Plus, you invite the scrutiny of auditors when you misvalue services.
During the 2019 Coding Updates Virtual Boot Camp for Anesthesia, Dennis explains how to properly report additional anesthesia services, choose the correct anatomical codes, and understand the documentation necessary to ensure that your practice keeps payment when an insurance company requests additional information.