The Trend Toward Code Consolidation
Darlene Helmer, CMA, CPC, ACS-AN, CMPE, MBA
Vice President of Provider Education and Training, Anesthesia Business Consultants, Jackson, MI
When one reviews the Current Procedural Terminology (CPT®) changes for 2015, a recurrent theme throughout is the consolidation of code combinations. The American Medical Association/ Specialty Society Relative Value Update Committee (RUC) identifies codes that are regularly reported together more than 75 percent of the time. The identified codes are then considered by the CPT Editorial Panel for bundling. The CPT Editorial Panel consists of physicians representing all specialties and other stakeholders who are all users of the CPT code set and thus have a practical perspective on the changes presented. It is the intention of the RUC, when presenting these code combinations, to provide the logic, rationale and function of these CPT changes. The following paragraphs will explore the rationale behind the bundled codes that are related to anesthesia and pain management.
Ultrasound is often utilized to improve the accuracy of intra-articular placement of the needle for safety and better patient outcomes. This is the reason why there are three new codes to describe ultrasound imaging guidance as an inclusive component of arthrocentesis, aspiration and/or injection of a joint or bursa (Table 1). Fluoroscopic-guided arthrocentesis will remain separately coded. It is important to note that the codes involving ultrasound guidance require the guidance to be recorded and a report to be included in the patient’s medical record. The original three codes were revised to describe these procedures without the use of ultrasound guidance as an option for the provider who is not utilizing ultrasound guidance for needle placement.
The RUC identified vertebroplasty codes 22520, 22521, 22522, 22523, 22524 and 22525 that were reported more than 75 percent of the time with 72291 (fluoroscopy). The decision was made to delete these codes and add six new comprehensive codes. The new codes are listed in Table 2. They all include imaging, moderate sedation and bone biopsy, when performed. The new codes require documentation of these comprehensive services in the patient’s permanent medical record. These new codes include primary as well as add on codes.
Table 3 sets forth one more set of procedures of interest to anesthesia and pain medicine providers. The myelography lumbar injection code 62284 and imaging guidance codes 72240, 72265 and 72270, for the professional component, were identified by RUC as codes reported together 75 percent or more of the time; therefore, four new codes were added to bundle the injection and imaging guidance for myelography procedures (62302- 62305). In addition, they retained the original codes, as these are occasionally performed by two separate providers and therefore would need to be billed separately.
Reviews of code combinations for possible bundling and revaluation of the services generally occur on an annual basis. One questions the motive behind this yearly review. Is it just to revalue services, or do the payers have an influence over this review to decrease the payment for separately billed services? Whatever the answer is, as utilization increases, combinations will occur. Interestingly enough, ICD-10 does an excellent job of creating combination codes in order to consolidate diagnosis codes that are regularly reported together. This is an overlapping occurrence between procedure and diagnosis coding.
Darlene F. Helmer, CMA, CPC, ACS-AN, CMPE, MBA serves as Vice President of Provider Education and Training for ABC. She has 30+ years of healthcare financial management and business experience. She works closely with the ABC compliance department and is a member of the ICD-10 training team. She is a long-standing member of MGMA, AHIMA, AAPC and other associations. She is a frequent speaker at local and state conferences. You can reach her at Darlene.Helmer@AnesthesiaLLC.com.