January 9, 2017

As part of our continuing efforts to keep you informed of developments that could have an impact on your practice, we present the following summary of coding and reimbursement changes for 2017, along with related documentation reminders.

Every year, the American Medical Association updates the CPT^® Standard Codebook with new codes, deletions and revisions to the descriptions of certain procedures.  These changes are critical to surgeons and other specialists and may have relevance to anesthesia providers in specific situations. Generally, chronic pain physicians need to pay closest attention to these updates. No changes were made to the Anesthesia CPT^® codes and only minimal changes were made to the ASA 2017 CROSSWALK^®.  The anesthesia basic value has been revised in a few procedures. 

The most significant code changes that impact anesthesia providers are the following:

Codes 62310, 62311, 62318 and 62319 have been eliminated.  These are very common codes for procedures that may be done with imaging (e.g., fluoroscopy or ultrasound).  The new codes for each make a distinction between a procedure done with imaging guidance and those done without imaging guidance.  The real significance of this change is that the provider must clearly document for each procedure whether or not imaging guidance is used.  

CPT has deleted and created codes for Epidural Steroid Injections (ESI).  The new code set is based on single injection versus catheter placement for continuous infusion/intermittent bolus and whether imaging guidance was used.  The following table describes the changes in detail.

The following is a simplified version reflecting the 2016 to 2017 ASA CROSSWALK^® based on the changes.

The Anesthesia and Resource Based Relative Value System (RBRVS) Conversion Factors increased slightly in 2017.   PLEASE NOTE:  The following figures represent the national average.  Click here to obtain the anesthesia conversion factors used to compute allowable amounts for anesthesia services in your area.

Moderate (Conscious) Sedation was completely restructured for 2017.  The sedation code ranges 99143-99145 and 99148-99150 were deleted, and six new sedation codes were created (99151-99157). 

The new code ranges are based on patient age and time.  The CPT time guideline for meeting the midway point is obsolete when coding the first level only.  Any service less than 10 minutes in duration is not reported separately.  Moderate (Conscious) Sedation is billed based on the intra-service time, which starts with the administration of the sedation agent(s), requires continuous face-to-face attendance, and ends at the conclusion of personal contact by the physician or Qualified Health Care Professional (QHCP).

Documentation requirements needed to correctly code these services are the total minutes of sedation and the name of the independent trained observer who is assisting in monitoring the patient’s level of consciousness and physiological status throughout the procedure. 

Following is a table outlining the total minute ranges, patient ages and the new codes to help you understand the coding concepts of the restructure.

PLEASE NOTE:  If you have a compensation model, some of these changes may affect the calculation for your disbursement.

Reminders Regarding Clinical Documentation

• Several code changes were made to Radiology in 2016.  The biggest change pertaining to anesthesia and pain management is the use of imaging guidance.  The following statement requirement has been added to the Introduction, Surgery and Medicine sections in the 2016 CPT^® Codebook and is still part of the 2017 CPT^® Codebook:  “When imaging guidance or imaging supervision and interpretation is included in a procedure, guidelines for image documentation and report, included in the guidelines for radiology (including nuclear medicine and diagnostic ultrasound) will apply.”
• The radiology section also includes a statement for “written reports.”  “A written report (e.g., handwritten or electronic) signed by the interpreting individual should be considered an integral part of a radiologic procedure or interpretation.  “Images” refer to those acquired in either an analog (i.e., film) or digital (i.e., electronic) manner.
• The image interpretation and report should include details of what the imaging was used for and the outcome of the use of the imaging, along with the medical necessity and documentation of where the image is stored/saved, etc.
• The dynamic technique used throughout the procedure, from vessel identification to needle placement within the vessel, may be reported separately depending on CPT guidelines, versus the static technique, which is used only to identify the vessel, not throughout the procedure and is not considered a reimbursable service.
• CPT descriptors utilize imaging verbiage in different ways throughout the CPT code set.  If imaging is required to perform the service (e.g., with imaging, including imaging, requiring imaging, inclusive of all imaging, etc.) the “written” requirement and imaging on file/stored/saved must still be documented.  If the description verbiage “when performed” is included, then the CPT code can be reported when imaging is utilized or not.  However, when it is utilized, the same imaging documentation is required.
• When Trigger Point Injections are performed, it is very important that all the muscles injected be documented by name because the coding is dependent on the number of muscles injected, not the number of injections.  Laterality is also important.
• Documentation of the patient’s physical status and any co-morbidities are important to include on all anesthesia records.  Often, this information helps to support the medical necessity for anesthesia.

ICD-10 went into effect on October 1, 2015 with a one-year “grace” period for submission of specified versus unspecified codes.  ABC prepared for this implementation well in advance, which turns out to have been a wise decision.  The transition has been smooth.  As of October 1, 2016, the “grace” period was lifted.  Some carriers have sent notifications that they will not accept unspecified codes. Therefore, please remember to be as specific as possible in the diagnosis description when documenting and to include the condition, site/laterality, cause (how the injury/health condition happened, place, activity, etc.), and qualifier (reason for or due to along with special details such as with/without bleeding/hemorrhage/obstruction, etc.) as applicable for each service performed.  ABC offers an ICD-10 hotline number (1-800-544-6647 #1) and help desk email to assist clients with any ICD-10 related questions.

The Office of the Inspector General (OIG) has reiterated for 2017 the same work plan for anesthesia-related services that was detailed in the 2016 work plan. 

We will review Medicare Part B claims for anesthesia services to determine whether they were supported in accordance with Medicare requirements.  Specifically, we will review anesthesia services to determine whether the beneficiary had a related Medicare service.  Medicare will not pay for items or services that are not “reasonable and necessary.”  We will review Medicare Part B claims for personally performed anesthesia services to determine whether they were supported in accordance with Medicare requirements. 

ABC clients:  If you have any other questions on the CPT Code changes for 2017, please contact your Vice President or Director.

With best wishes,

Tony Mira
President and CEO