02/08/2019 – Year End

Question: Are there any coding changes that anesthesiologists should be aware of for 2019?

Answer: Yes, there has been one deleted code as well as some revised codes and comments. The CPT has also published some new instructions on documentation requirements for ultrasound guidance. The ASA’s RVG booklet additionally offers some refined changes to the definition of time and field avoidance. Please see key points below as summarized and quoted from the ASA.

There are no changes to the Anesthesia codes for 2019.  CPT’s Anesthesia Guidelines have been updated to include information on unlisted services/procedures.  This update does not involve new information, but its addition makes the Anesthesia Guidelines more consistent with the guidelines for other sections of CPT relative to this matter.

ASA members who provide pain medicine care may see a few changes for their practices, as follows:

  • Code 64508 – Injection, anesthetic agent; carotid sinus (separate procedure) – has been deleted.
  • Significant changes to both the codes and the instructions associated with the analysis and programming of neurostimulators.   Codes 95970, 95971 and 95972 have been revised, new codes have been added to this section and other codes within it are deleted for 2019.  Instructions provide clarification on how all these codes are to be reported.  For example:
    • The codes for cranial nerve, spinal cord, peripheral nerve and sacral nerve neurostimulator analysis are reported based on the number of parameters adjusted during a session.  Simple programing involves adjustment of one to three parameters and complex programing requires adjustment of more than three parameters.   If a single parameter is adjusted multiple times during a session, that counts as one parameter.
    • Analysis is considered inherent to implementation and not to be reported separately if done during the same session.

2019 CPT includes new instructions specific to imaging guidance.  This is important since imaging is bundled into many of the pain procedures.
The new CPT instruction as it appears in the Surgery Guidelines states that,

“When imaging guidance or imaging supervision and interpretation is included in a surgical procedure, guidelines for image documentation and report, included in the guidelines for Radiology (Including Nuclear Medicine and Diagnostic Ultrasound), will apply.” 

 “Imaging may be required during the performance of certain procedures or certain imaging procedures may require surgical procedures to access the imaged area.  Many services include image guidance, and imaging guidance is not separately reportable when it is included in the base service.  The CPT code set typically defines in descriptors and/or guidelines when imaging guidance is included.  When imaging is not included in a surgical procedure or procedure from the Medicine section, image guidance codes or codes labeled “radiological supervision and interpretation” (RS&I) may be reported for the portion of the service that requires imaging.  All imaging guidance codes require: (1) image documentation in the patient record and (2) description of imaging guidance in the procedure report.  All RS&I codes require: (1) image documentation in the patient’s permanent record and (2) a procedure report or separate imaging report that includes written documentation of interpretive findings of information contained in the images and radiologic supervision of the service.”

The Relative Value guide booklet published the following new/revised coding comments regarding time, focusing on discontinuous time:

2018 RVG: Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia care in the operating room or in an equivalent area, and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient is safely placed under post-anesthesia supervision.

2019 RVG:  Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient.  It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is, when the patient is safely placed under postoperative care.  Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service.  In counting anesthesia time for services furnished, the anesthesia practitioner can add blocks of time around an interruption in anesthesia time as long as the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption.

Field avoidance is also addressed by the RVG with a focus on patient airway as opposed to position only:

2018 RVG:  Any procedure around the head, neck, or shoulder girdle, requiring field avoidance, or any procedure requiring a position other than supine or lithotomy, has a minimum Base Value of 5 regardless of any lesser base value assigned to such procedure in the body of the Relative Value Guide.

2019 RVG: Whenever access to the airway is limited (eg, field avoidance), the anesthesia work required may be substantially greater compared to the typical patient.  This anesthesia care has a minimum base unit value of 5 regardless of any lesser base unit valued assigned to such procedure in the body of the Relative Value Guide. 

The RVG booklet added a few revisions to the comments as well to the following codes:

00530 Anesthesia for permanent transvenous pacemaker insertion now states, “A pacemaker consists of a pulse generator, electronics and a battery with or without one or more leads.

0056 Anesthesia for direct coronary artery bypass grafting; without pump oxygenator, the comment, “do not report code 00566 in conjunction with code +99166 or +99135” has been removed.

99166 Anesthesia complicated by total boy hypothermia and 99135 controlled hypotension, may now be reported with ASA code 00566.








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