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CPT Changes in Anesthesia Billing and
Coding for 2004
February
25, 2004 – Effective
January 1, 2004, hundreds of coding additions, revisions and deletions affecting
how the medical profession communicates procedures and services were made. This
article highlights those revisions which most significantly impact anesthesia
and pain management providers.
New Codes
The
following two tables describe 30 surgical and anesthesia codes, which have been
added to CPT 2004. The most significant addition is a series of 24 new codes for
central venous access. Note: codes 36488-36491, involving placement of CVP with
or without cutdown, have been deleted.
|
New CVP Code |
Description
|
Base Units |
|
36555 |
Insertion of
non-tunneled central venous catheter; patient under five years of age
|
5 |
|
36556 |
Insertion of non-tunneled central venous catheter; patient five years or
older |
4 |
|
36557 |
Insertion of tunneled central venous catheter; patient under five years of
age |
4 |
|
36558 |
Insertion of
tunneled central venous catheter; patient five years or older
|
4 |
|
36560 |
Insertion of tunneled central venous access device, with subcutaneous port;
patient under five years of age |
4 |
|
36561 |
Insertion of tunneled central venous access device, with subcutaneous port;
patient five years or older |
4 |
|
36563 |
Insertion of tunneled central venous access device with subcutaneous pump |
4 |
|
36565 |
Insertion of tunneled centrally inserted central venous access device,
requiring two catheters via two separate venous access sites; without
subcutaneous port or pump |
4 |
|
36566 |
Insertion of tunneled centrally inserted central venous access device,
requiring two catheters via two separate venous access sites; with
subcutaneous port(s) |
4 |
|
36568 |
Insertion of peripherally inserted central venous catheter, without
subcutaneous port or pump; patient under five years of age |
4 |
|
36569 |
Insertion of peripherally inserted central venous catheter, without
subcutaneous port or pump; patient five years or older |
4 |
|
36570 |
Insertion of peripherally inserted central venous access device, with
subcutaneous port; patient under five years of age |
4 |
|
36571 |
Insertion of peripherally inserted central venous access device, with
subcutaneous port; patient five years or older |
4 |
|
|
REPAIR of central
venous device: |
|
|
36575 |
Repair of tunneled or non-tunneled central venous access catheter, without
subcutaneous port or pump, central or peripheral insertion site |
3 |
|
36576 |
Repair of central venous access device, with subcutaneous port or pump,
central or peripheral insertion site |
3 |
|
|
Partial
REPLACEMENT of Catheter: |
|
|
36578 |
Replacement, catheter only, of central venous access device, with
subcutaneous port or pump, central or peripheral insertion site |
4 |
|
|
TOTAL REPLACEMENT of
central venous device; same venous access site: |
|
|
36580 |
Replacement, complete, of a non-tunneled centrally inserted central venous
catheter, without subcutaneous port or pump, through same venous access |
4 |
|
36581 |
Replacement, complete, of a tunneled centrally inserted central venous
catheter, without subcutaneous port or pump, through same venous access |
4 |
|
36582 |
Replacement, complete, of a tunneled centrally inserted central venous
access device, with subcutaneous port, through same venous access |
4 |
|
36583 |
Replacement, complete, of a tunneled centrally inserted central venous
access device, with subcutaneous pump, through same venous access |
4 |
|
36584 |
Replacement, complete, of a peripherally inserted central venous catheter,
without subcutaneous port or pump, through same venous access |
4 |
|
36585 |
Replacement, complete, of a peripherally inserted central venous access
device, with subcutaneous port, through same venous access |
4 |
|
|
REMOVAL of central
venous access device: |
|
|
36589 |
Removal of tunneled central venous catheter, without subcutaneous port or
pump |
3 |
|
|
Removal of tunneled central venous access device, with subcutaneous port or
pump; central or peripheral insertion |
3 |
|
|
Mechanical Removal of
Obstructive Material: |
|
|
36595 |
Mechanical removal of pericatheter obstructive material (eg. fibrin sheath)
from central venous device via separate venous access |
4 |
|
36596 |
Mechanical removal of intraluminal (intracatheter) obstructive material from
central venous device through device lumen |
4 |
|
|
OTHER central venous
access procedures: |
|
|
36597 |
Repositioning of previously placed central venous catheter under
fluoroscopic guidance |
4 |
Other new codes, specific to anesthesia in the thoracic and pelvic areas and in
the delivery room, are listed below. Of note: Anesthesia for closed chest
procedure; mediastinoscopy and diagnostic thoracoscopy, not utilizing one lung
ventilation carries 8 base units. Also, the American Society of
Anesthesiologists’ code for open repair of pelvic fractures (01175), which was
not included in the CPT 2003 book, carries a base of 10. A note for obstetric
anesthesia: 01958 is used only when the cephalic version has been performed
independent of delivery. If delivery follows version with no break in the
anesthesia service, only the service representing the most complex procedure is
reported. It is imperative that the anesthesiologist clearly document an
independent cephalic version or, when delivery follows, include the time spent
providing anesthesia for the version.
|
New Anesthesia
Code |
Description |
Base Units |
|
00529 |
Anesthesia for closed chest procedures; (including bronchoscopy) not
otherwise specified; mediastinoscopy and diagnostic thoracoscopy utilizing
one lung ventilation |
11 |
|
01173 |
Anesthesia for open repair of fracture disruption of pelvis or column
fracture involving acetabulum |
12 |
|
01958 |
Anesthesia for external cephalic version procedure |
5 |
New Add-On Codes
Radiological guidance add-on codes are used in conjunction with codes for the
primary procedure performed. The add-on code applies only to procedures and
services administered by the same physician. The following two codes, which are
more applicable to anesthesia, have been added this year, along with others less
applicable to the specialty.
|
New Radiological
Guidance Code |
Description
|
Base Unit(s) |
|
75998 |
Fluoroscopic guidance for central venous access device placement,
replacement (catheter only or complete), or removal (includes fluoroscopic
guidance for vascular access and catheter manipulation, any necessary
contrast injections through access site or catheter with related venography
radiologic supervision and interpretation, and radiographic documentation of
final catheter position) (List separately in addition to code for primary
procedure) |
2 |
|
76937 |
Ultrasound guidance for vascular access requiring ultrasound evaluation of
potential access sites, documentation of selected vessel patency, concurrent
realtime ultrasound visualization of vascular needle entry, with permanent
recording and reporting (List separately in addition to code for primary
procedure) |
1 |
Daily Hospital Management Revision
The
anesthesia code for daily hospital management of epidural or subarachnoid
continuous drug administration has been revised from 2003. CPT has removed the
caveat, “placed primarily for anesthesia administration during an operative
session, but retained for post-operative pain management.” The 2004 instruction
states simply, “(Report code 01996 for daily hospital management of continuous
epidural or subarachnoid drug administration performed after insertion of an
epidural or subarachnoid catheter).” It is no longer necessary to document the
intent of the original insertion at the time of insertion.
Coding Changes for Pain Management
The
following new and revised codes in CPT 2004 will affect pain management
providers.
Note: The AMA has added the superior hypograstic plexus to the list of codes in
the nervous system section of the book. Fluoroscopic guidance (76003) is not
included in the pelvic area injection code and may be separately reported. Also
of note: The physician should clearly indicate in the medical record his or her
personal performance of the pump refill described by code 95991.
|
New Code |
Description
|
|
64449 |
Injection, anesthetic agent; lumbar plexus, posterior approach, continuous
infusion by catheter (including catheter placement) including daily
management for anesthetic agent administration
(do not report 01996 in conjunction with 64449) |
|
64517 |
Injection, anesthetic agent, superior hypogastric plexus |
|
64681 |
Destruction by neurolytic agent, with or without radiologic monitoring;
superior hypogastric plexus |
|
95991 |
Refilling and maintenance of implantable pump or reservior for drug
delivery, spinal (intrathecal, epidural) or brain (intraventricular);
administered by physician |
Revised Pain Management Codes
A
few of the surgical codes used most by pain management anesthesiologists have
been revised in the new edition of CPT. The AMA has indicated muscle(s),
instead of muscle group(s). The tendon and trigger point (muscle)
injection codes, previously in the same code family, have been separated. As
such, it will be important to specify trigger point or tendon injections in your
dictation. For radiology codes of the spine and pelvis, language has been added
that makes it imperative for physicians to specifically document radiological
supervision and interpretation. These changes are spelled out below:
|
Revised Pain Code |
Description |
|
20552 |
Injection(s); single or multiple trigger point(s), one or two muscle(s) |
|
20553 |
Injection(s); single or multiple trigger point(s), three or more muscles |
|
72270 |
Myelography, two or more regions (eg. lumbar/thoracic, cervical/thoracic,
lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and
interpretation |
|
72275 |
Epidurography, radiological supervision and interpretation
(Use 72275 only when an epidurogram is performed, images documented, and a
formal radiologic report is issued) |
Reimbursement continues to depend heavily on the accuracy of a physician’s
documentation. The buck starts here: in pre-op, with accurate recording of
diagnoses, procedures, services, exact time spent on each case, the physician or
provider(s) involved and any extenuating circumstances. Coding of charge
tickets and success with Medicare and third party payers is a direct reflection
of the comprehensiveness of the record.
In
order to serve you better, South Oakland Services is committed to providing
up-to-date information on changes in payment rules and regulations to guide
clients toward appropriate and thorough documentation, with a focus on optimal
reimbursement. If you would like more information or clarification, please
contact South Oakland Services, Inc.
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