CPT 2012: 62310, 62318 Revisions Help Simplify Your Single Shot vs. Indwelling Catheter Coding

Plus: Get ready for changes to 77003, too.

Though you won't report new or revised CPT® anesthesia codes until January 2012, get ready -- and your anesthesia providers -- at this time for revisions that can impact your everyday coding, for instance the rewording of two general epidural codes.

Observe the Descriptor Differences

The chief modifications are applicable to epidural codes 62310 along with 62318. The existing and upcoming descriptors are as follows:

The novel descriptors include several changes:

62310 specifies that it can be used for more than one single injection.

62310 no longer statesthe possible use for epidurography. Epidurography is a distinct procedure that doesn't need to be associated with this code.

The existing version of 62310 doesn't involve catheter administration, however the revised descriptor does. Physicians were placing catheters for single shots and trying to bill 62310 or 62311. The dissimilarity is that one pair of anesthesia codes is for constant or continuous bolus (62318/62319). The other is for a single distinct dose at a time (62310/62311), irrespective of catheter use.

The revised 62318 explains "indwelling" catheter and changes from "injection" to "injections".

Keep in mind: Anesthesia codes 62311 as well as 62319 now read "lumbar or sacral (caudal)" in place of "lumbar; sacral (caudal)."


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Don't Miss Fluoro and Nerve Destruction Changes

In case you occasionally report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) in combination with diagnostic or therapeutic injections, make certain that you note the descriptor change, come January.

The novel descriptor will read "Fluoroscopic guidance and localization or needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid)."

Change: The code no longer covers guidance for sacroiliac joint injections or neurolytic agent destruction.

Replacements: Codes 64622-64627 for paravertebral facet joint nerve destruction have been deleted and replaced with following listed four novel anesthesia codes :

64633 – i.e. Destruction by means of neurolytic agent, paravertebral facet joint nerve(s) including imaging guidance (fluoroscopy or CT); cervical or thoracic, as well as single facet joint

64634 -- i.e.... cervical or thoracic, every additional facet joint (List separately in addition to code for primary procedure)

64635 -- i.e.... lumbar or sacral, as well as single facet joint

64636 -- i.e.... lumbar or sacral, every additional facet joint (List separately in addition to code for primary procedure).

Simplify CABG Coding With These Expert Tips

Surgeon's documentation also helps boost your coding accuracy.

While coding for anesthesia during coronary artery bypass graft (CABG) procedures, aspects like the patient's age and whether physicians' usage of specialized equipment while carrying out surgery can affect your reporting.

Do Examine the Code Choices

CPT® includes three anesthesia codes during CABG procedures:

00562 – i.e. Anesthesia carried out for procedures on heart, pericardial sac, along with great vessels of chest; including pump oxygenator, with age 1 year or older, meant for all non-coronary bypass procedures (for instance valve procedures) or for carrying out re-operation for coronary bypass more than 1 month after original operation

00566 -- i.e. Anesthesia carried out for direct coronary artery bypass grafting; excluding pump oxygenator

00567 -- i.e. Anesthesia for direct coronary artery bypass grafting; including pump oxygenator.

The associated base units differ according to the procedure. Code 00562 carries 20 base units, code 00566 carries 25 base units, and code 00567 carries 18 base units.

Do Watch for Pump Documentation

The first question you are required to answer when coding anesthesia during CABG is whether the anesthesiologist carried out the use of a pump oxygenator during the procedure.

Definitions: A case is deliberated "on pump" once the physician uses a pump oxygenator to stop the patient's heart and lungs during surgery. An "off pump" case takes place when the surgeon carries out the operation on the patient's still-beating heart.

The physician should document ‘off pump' prior to you can report the anesthesia codes that have higher base unit values. It can be worth almost $85 more for a normal Medicare case, but you must ensure that your anesthesiologist has rightfully earned it before you code it.

Don't Always Add Qualifying Circumstances

Some payers permit coders to report "qualifying circumstances" anesthesia codes that clarify features of the patient's situation that made the anesthesiologist's work complicated. Three of these anesthesia codes might apply to cardiovascular cases:

99100 – i.e. Anesthesia meant for patient of extreme age, for patients younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)

99116 -- i.e. Anesthesia which is complicated by utilization of entire body hypothermia (List separately in addition to code for primary anesthesia procedure)

99135 -- i.e. Anesthesia which is complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure).

Don't automatically include these anesthesia codes with all CABG procedures.

Do Look for Notes That Add Units

Go through your anesthesiologist's notes and the operative report sensibly, as documentation can occasionally justify extra base units.

For instance, in case the surgeon sews a graft in an off -pump procedure, the anesthesiologist is due one additional unit owing to the increased risk. You can also shift from 18 base units with 00567 to 20 base units with 00562 in case the CABG procedure involves another heart procedure for instance valve placement or in case the patient is having a re-do CABG more than one month post an original CABG surgery.