ASA December 2003 Newsletter

December 2003 Volume 67	Number 12

Changes in Anesthesia and Pain Medicine Coding for 2004

Karin Bierstein, J.D.
Assistant Director of Governmental Affairs (Regulatory)

The ASA Committee on Economics has had another busy year of proposing and effecting changes in the Current Procedural Terminology (CPT™) codes used to report services performed by anesthesiologists. The members who represent ASA on the CPT Editorial Panel and on the Relative Value Update Committee (RUC), in particular, deserve their colleagues’ thanks.

Anesthesia Codes
The 2004 CPT book will include new or revised codes for anesthesia for three procedures: mediastinoscopy and diagnostic thoracoscopy using one-lung ventilation, repair of acetabular fracture and external cephalic version. See Table 1 for the codes and their assigned base unit values, which have been adopted by the Centers for Medicare & Medicaid Services (CMS).

The 2004 CPT book also contains a much-needed revision to the usage instructions for code 01996 (daily hospital management of epidural or subarachnoid continuous drug administration) as discussed in this column in the November 2003 NEWSLETTER. After December 31, anesthesiologists will no longer report evaluation and management codes instead of 01996 if the epidural was placed solely for postoperative pain management. The instructions for the corresponding epidural codes, 62318 and 62319, also have been revised to reflect that 01996 is the correct code for daily management of the epidural in all instances. The 2004 ASA Relative Value Guide contains the new language.

Central Venous Catheters
There also are important changes to the codes used to report central venous access procedures. Please see Table 2 for changes that will be of interest to anesthesiologists.

Of more general interest, this entire section of the CPT book has been deleted and replaced by new, more specific codes. The new codes distinguish between centrally placed or peripherally placed catheters, tunneled or nontunneled catheters and whether or not a subcutaneous port or pump has been placed.

There are separate codes for insertion, repair, partial replacement, complete replacement and, where appropriate, removal. The new insertion codes do not differentiate between a percutaneous placement and a cutdown. There are separate codes for adults and children (under 5 years of age or age 5 years or older). Additionally there are two new add-on codes to report fluoroscopic or ultrasound guidance for device placement or catheter manipulation.

Pain Medicine
ASA brought three new pain codes through the processes of the CPT Editorial Panel and the RUC (which recommends relative values to CMS for adoption). The American Society for Interventional Pain Physicians and the American Academy of Pain Medicine were instrumental in this effort. Included in CPT for 2004 are a continuous lumbar plexus block, a superior hypogastric plexus block and a superior hypogastric plexus neurolytic. Table 3 lists these and other pain coding changes.


	Order Your 2004 Relative Value Guide and CROSSWALK™ We expect the ASA 2004 Relative Value Guide (RVG) and CROSSWALK™ to be available in December 2003. Both books have been revised to include all the 2004 coding changes. The Committee on Economics decided to eliminate from the RVG and CROSSWALK™ those codes that CPT had never adopted. This is because under the Health Insurance Portability and Accountability Act (HIPAA), physicians may only report procedure codes that appear in official code sets such as CPT. One anesthesia service affected is 01997 (daily hospital management of patient-controlled analgesia [PCA]), which is unique to the RVG. With its removal from the 2004 book, daily management of PCA should be reported using the evaluation and management codes, if they apply. The 2004 RVG contains more ASA coding notes, the italicized comments provided to help clarify code use. It also contains the ASA “Position on Monitored Anesthesia Care” and “Statement on Intravascular Catheterization Procedures” (formerly Invasive Monitoring) as amended by the ASA House of Delegates on October 15, 2003.

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