Sample page. Anesthesia Services. Coding and Payment Guide

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1 Coding and Payment Guide 2018 Anesthesia Services An essential coding, billing and reimbursement resource for anesthesiology and pain management POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com.

2 Contents Getting Started with Coding and Payment Guide...1 Resequencing of CPT Codes...1 ICD-10-CM...1 Detailed Code Information...1 CCI Edit Updates...1 Index...1 General Guidelines...1 Sample Page and Key...1 Procedure Codes...5 Structure the of CPT Book...5 CPT Coding Conventions...5 Unlisted Procedures...5 Modifiers...6 Payment for Anesthesia Services...7 Payment for Surgical Services and Procedures...7 Global Surgery Packages...8 Bundled Services Anesthesia...9 Anesthesia for Head...11 Anesthesia for Neck...43 Anesthesia, Thorax (Chest Wall/Shoulder)...50 Anesthesia for Intrathoracic...58 Anesthesia for Spine and Spinal Cord...76 Anesthesia for Upper Abdomen...82 Anesthesia for Lower Abdomen...93 Anesthesia for Perineum Anesthesia for Pelvis (Except Hip Anesthesia for Upper Leg (Except Knee) Anesthesia for Knee and Popliteal Area Anesthesia Lower Leg (Below Knee w Ankle/Foot) Anesthesia for Shoulder and Axilla Anesthesia for Upper Arm and Elbow Anesthesia for Forearm, Wrist and Hand Anesthesia for Radiologic Procedures Anesthesia for Burn Excisions or Debridement Anesthesia for Obstetrical Procedures Anesthesia for Other Procedures Musculoskeletal System Respiratory System Cardiovascular System Spine and Spinal Cord Somatic Nerve Blocks Paravertebral Spinal Nerves/Branches Sympathetic Nerve Blocks Peripheral Nerve Neurostimulators Destruction by Neurolytic Agent Radiology Medicine Correct Coding Initiative Update CPT Index Medicare Official Regulatory Information The CMS Online Manual System Glossary Contents i

3 Getting Started with Coding and Payment Guide The is designed to be a guide to the specialty procedures classified in the CPT book. It is structured to help coders understand procedures and translate physician narrative into correct CPT codes by combining many clinical resources into one, easy-to-use source book. The book also allows coders to validate the intended code selection by providing an easy-to-understand explanation of the procedure and associated conditions or indications for performing the various procedures. As a result, data quality and reimbursement will be improved by providing code-specific clinical information and helpful tips regarding the coding of procedures. For ease of use, Coding and Payment Guide for Anesthesia Services lists the CPT and HCPCS Level II codes in ascending numeric order. Included in the code set are all surgery and medicine codes pertinent to the specialty. Each CPT code is followed by its official code description. Resequencing of CPT Codes The American Medical Association (AMA) employs a resequenced numbering methodology. According to the AMA, there are instances where a new code is needed within an existing grouping of codes, but an unused code number is not available to keep the range sequential. In the instance where the existing codes were not changed nor had only minimal changes, the AMA has assigned a code out of numeric sequence with the other related codes being grouped together. The resequenced codes and their descriptions have been placed with their related codes, out of numeric sequence. Codes within the Optum360 Coding and Payment Guide series display in their resequenced order. Resequenced codes are enclosed in brackets for easy identification. ICD-10-CM Overall, the 10th revision goes into greater clinical detail than did ICD-9-CM and addresses information about previously classified diseases, as well as those diseases discovered since the last revision. Conditions are grouped with general epidemiological purposes and the evaluation of health care in mind. New features have been added, and conditions have been reorganized, although the format and conventions of the classification remain unchanged for the most part. Detailed Code Information One or more columns are dedicated to each procedure or service to a series of similar procedures/services. Following the specific CPT code and its narrative, is a combination of features. A sample is shown on page 2. The black boxes with numbers in them correspond to the information on the page following the example. CCI Edit Updates The Coding and Payment Guide series includes the a list of codes from the official Centers for Medicare and Medicaid Services National Correct Coding Policy Manual for Part B Medicare Contractors that are considered to be an integral part of the comprehensive code or mutually exclusive of it and should not be reported separately. The codes in the Correct Coding Initiative (CCI) section are from version 23.3, the most current version available at press time. The CCI edits are now located in a section at the back of the book. Optum360 maintains a website to accompany the Coding and Payment Guide series and posts updated CCI edits on this website so that current information is available before the next edition. The website address is The 2017 edition password is: SPEC17DLC. Please note that you should log in each quarter to ensure you receive the most current updates. An reminder will also be sent to you to let you know when the updates are available. Index A comprehensive index is provided for easy access to the codes. The index entries have several axes. A code can be looked up by its procedural name or by the diagnoses commonly associated with it. Codes are also indexed anatomically. For example: Arm Lower, 00400, Arteries, Bones, Closed, General Guidelines Providers The AMA advises coders that while a particular service or procedure may be assigned to a specific section, the service or procedure itself is not limited to use only by that specialty group. Additionally, the procedures and services listed throughout the book are for use by any qualified physician or other qualified health care professional or entity (e.g., hospitals, laboratories, or home health agencies). Keep in mind that there may be other policies or guidance that can affect who may report a specific service. Supplies Some payers may allow physicians to separately report drugs and other supplies when reporting the place of service as office or other nonfacility setting. Drugs and supplies are to be reported by the facility only when performed in a facility setting. Professional and Technical Component Some pathology codes have a technical and a professional component. When physicians do not own their own equipment and send their patients to outside testing facilities, they should append modifier 26 to the procedural code to indicate they performed only the professional component. Sample Page and Key On the following pages are a sample page from the book displaying the format of Coding and Payment Guide with each element identified and explained on the opposite page. Getting Started with Coding and Payment Guide 1

4 Anesthesia for Intrathoracic Anesthesia for closed chest procedures; needle biopsy of pleura pneumocentesis Coding Tips To report anesthesia during bronchoscopy, see code To report anesthesia during a mediastinoscopy, see codes Terms To Know biopsy. Tissue or fluid removed for diagnostic purposes through analysis of the cells in the biopsy material. centesis. Puncture. pleura. Thin membrane covering the lungs and lining the inside of the chest wall. pneum(o)-. Relating to respiration, air, the lungs. Surgical to Anesthesia Code Crosswalk 0340T, 32400, 32405, 32554, 32555, ICD-10-CM Diagnostic Codes A06.5 Amebic lung abscess A15.0 Tuberculosis of lung A15.6 Tuberculous pleurisy A15.7 Primary respiratory tuberculosis A15.8 Other respiratory tuberculosis A48.1 Legionnaires' disease B25.0 Cytomegaloviral pneumonitis B37.1 Pulmonary candidiasis B44.0 Invasive pulmonary aspergillosis B44.81 Allergic bronchopulmonary aspergillosis B59 Pneumocystosis C34.01 Malignant neoplasm of right main bronchus C34.02 Malignant neoplasm of left main bronchus C34.11 Malignant neoplasm of upper lobe, right bronchus or lung C34.2 Malignant neoplasm of middle lobe, bronchus or lung C34.31 Malignant neoplasm of lower lobe, right bronchus or lung C34.81 C38.4 C38.8 C45.0 C46.51 C78.01 C78.2 D02.21 D14.31 D19.0 D38.1 D38.2 J14 J15.0 J15.1 J Malignant neoplasm of overlapping sites of right bronchus and lung Malignant neoplasm of pleura Malignant neoplasm of overlapping sites of heart, mediastinum and pleura Mesothelioma of pleura Kaposi's sarcoma of right lung Secondary malignant neoplasm of right lung Secondary malignant neoplasm of pleura Carcinoma in situ of right bronchus and lung Benign neoplasm of right bronchus and lung Benign neoplasm of mesothelial tissue of pleura Neoplasm of uncertain behavior of trachea, bronchus and lung Neoplasm of uncertain behavior of pleura Pneumonia due to Hemophilus influenzae Pneumonia due to Klebsiella pneumoniae Pneumonia due to Pseudomonas Pneumonia due to Methicillin susceptible Staphylococcus aureus J J15.29 J15.3 J15.4 J15.5 J15.6 J15.7 J15.8 J16.0 J16.8 J85.0 J85.1 J85.2 J86.0 J86.9 J90 J91.0 J91.8 J92.0 J92.9 J94.0 J94.1 J94.2 J94.8 J98.4 M32.13 Q34.0 Medicare Edits Pneumonia due to Methicillin resistant Staphylococcus aureus Pneumonia due to other staphylococcus Pneumonia due to streptococcus, group B Pneumonia due to other streptococci Pneumonia due to Escherichia coli Pneumonia due to other aerobic Gram-negative bacteria Pneumonia due to Mycoplasma pneumoniae Pneumonia due to other specified bacteria Chlamydial pneumonia Pneumonia due to other specified infectious organisms Gangrene and necrosis of lung Abscess of lung with pneumonia Abscess of lung without pneumonia Pyothorax with fistula Pyothorax without fistula Pleural effusion, not elsewhere classified Malignant pleural effusion Pleural effusion in other conditions classified elsewhere Pleural plaque with presence of asbestos Pleural plaque without asbestos Chylous effusion Fibrothorax Hemothorax Other specified pleural conditions Other disorders of lung Lung involvement in systemic lupus erythematosus Anomaly of pleura Base Units * with documentation Modifiers Time/Minutes FUD Status J J Medicare References ,4,20.6.4; ,4, Anesthesia for Intrathoracic

5 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance with imaging guidance (ie, fluoroscopy or CT) Explanation The patient is placed in the sitting or lateral decubitus position for the physician to insert a catheter into the vertebral interspace of the lumbar or sacral for continuous or intermittent infusion of material. The site to be entered is sterilized, local anesthesia is administered, and the infusion catheter is inserted. The physician provides continuous infusion or intermittent bolus injection of solution to provide a therapeutic or diagnostic outcome. The solution is injected into the interlaminar epidural or subarachnoid space. When the procedure is complete, the catheter is removed and the wound is dressed. Report when this procedure is performed without imaging guidance and when imaging guidance is utilized. Coding Tips These codes are new for Code replaces 62319, which has been deleted. Do not report with 77003, 77012, or Report for daily hospital management of continuous epidural or subarachnoid drug administration performed with Documentation Tips Documentation should indicate the level of the injection and the substance(s) administered. ICD-10-CM Diagnostic Codes M43.27 Fusion of spine, lumbosacral M43.28 Fusion of spine, sacral and sacrococcygeal M47.15 Other spondylosis with myelopathy, thoracolumbar M47.16 Other spondylosis with myelopathy, lumbar M47.25 Other spondylosis with radiculopathy, thoracolumbar M47.26 Other spondylosis with radiculopathy, lumbar M47.27 Other spondylosis with radiculopathy, lumbosacral M47.28 M M M M M M M M48.05 M48.06 M48.07 M51.15 M51.16 Other spondylosis with radiculopathy, sacral and sacrococcygeal Spondylosis without myelopathy or radiculopathy, thoracolumbar Spondylosis without myelopathy or radiculopathy, lumbar Spondylosis without myelopathy or radiculopathy, lumbosacral Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal Other spondylosis, thoracolumbar Other spondylosis, lumbar Other spondylosis, lumbosacral Spinal stenosis, thoracolumbar Spinal stenosis, lumbar Spinal stenosis, lumbosacral Intervertebral disc disorders with radiculopathy, thoracolumbar Intervertebral disc disorders with radiculopathy, lumbar M51.17 M51.25 M51.26 M51.27 M51.35 M51.36 M51.37 M51.45 M51.46 M51.47 M51.85 M51.86 M51.87 M53.2X7 M53.2X8 M53.3 M53.86 M53.87 M53.88 M54.15 M54.16 M54.17 M54.31 M54.32 M54.41 M54.42 M54.5 M99.23 M99.33 M99.43 M99.53 M99.63 M99.73 Medicare Edits Intervertebral disc disorders with radiculopathy, lumbosacral Other intervertebral disc displacement, thoracolumbar Other intervertebral disc displacement, lumbar Other intervertebral disc displacement, lumbosacral Other intervertebral disc degeneration, thoracolumbar Other intervertebral disc degeneration, lumbar Other intervertebral disc degeneration, lumbosacral Schmorl's nodes, thoracolumbar Schmorl's nodes, lumbar Schmorl's nodes, lumbosacral Other intervertebral disc disorders, thoracolumbar Other intervertebral disc disorders, lumbar Other intervertebral disc disorders, lumbosacral Spinal instabilities, lumbosacral Spinal instabilities, sacral and sacrococcygeal Sacrococcygeal disorders, not elsewhere classified Other specified dorsopathies, lumbar Other specified dorsopathies, lumbosacral Other specified dorsopathies, sacral and sacrococcygeal Radiculopathy, thoracolumbar Radiculopathy, lumbar Radiculopathy, lumbosacral Sciatica, right side Sciatica, left side Lumbago with sciatica, right side Lumbago with sciatica, left side Low back pain Subluxation stenosis of neural canal of lumbar Osseous stenosis of neural canal of lumbar Connective tissue stenosis of neural canal of lumbar Intervertebral disc stenosis of neural canal of lumbar Osseous and subluxation stenosis of intervertebral foramina of lumbar Connective tissue and disc stenosis of intervertebral foramina of lumbar Fac RVU * with documentation Non-Fac RVU Modifiers FUD 0 0 Status A A MUE - - Medicare References None Spine and Spinal Cord Spine and Spinal Cord 241