02/04/2020 – Code Changes for 2020

Question: Are there any code changes that apply to anesthesia in 2020?

Answer: There were no changes to anesthesia codes for 2020. There are, however, some changes to pain management codes that may affect you—they are listed below:

2019 codes 2020 codes Anesthetic agent injections 64999 unlisted procedure, nervous system 64451 (Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography))

64999 unlisted procedure, nervous system 64454 (Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed). Nerve destruction 64999 unlisted procedure, nervous system 64624 (Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed)

64999 unlisted procedure, nervous system 64625 (Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)).

Codes that have been deleted in 2020
The following codes have been deleted for 2020. Going forward, use “unlisted code 64999” as a substitute—be sure to include supporting documentation, too.

2019 codes 2020 codes 64402 (Injection, anesthetic agent; facial nerve) 64999 unlisted procedure, nervous system 64410 (Injection, anesthetic agent; phrenic nerve) 64999 unlisted procedure, nervous system 64413 (Injection, anesthetic agent; cervical plexus). 64999 unlisted procedure, nervous system

Revised “Injection” Codes Several frequently-used anesthetic injection codes have been revised in 2020. Each descriptor has been expanded to include “anesthetic agent(s) and/or steroid.” There are too many affected codes to list here, but a few examples are:

2019 code descriptor 2020 revision 64400 injection, anesthetic agent; trigeminal nerve, any division or branch 64400 (Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular))

64405 injection, anesthetic agent, greater occipital nerve
64405 (Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve)

64415 injection, anesthetic agent; brachial plexus, single
64415 (Injection(s), anesthetic agent(s) and/or steroid; brachial plexus)

64416 injection, anesthetic agent, brachial plexus, continuous infusion by catheter
64416 (Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous infusion by catheter (including catheter placement))

64417 injection, anesthetic agent; axillary nerve 64417 (Injection(s), anesthetic agent(s) and/or steroid; axillary nerve)

64420 injection, anesthetic agent, intercostal nerve, single
64420 (Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level)

64450 injection, anesthetic agent, other peripheral nerve or branch
64450 (Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch).

But there’s more: The “steroid” addition to the descriptor isn’t the only change for some of these procedure codes. For example, the current descriptor for 64400 is “Injection, anesthetic agent; trigeminal nerve, any division or branch.” The revised descriptor for 2020 specifies the applicable nerve branches rather than using the general term “any.”

As another example, the current descriptor for code 64421 is “Injection, anesthetic agent; intercostal nerves, multiple, regional block.” Beginning in January 2020, it will be considered an add-on code that can only be reported in conjunction with a primary procedure code.

Cataract CPT code changes

The CPT codes for cataract procedures were updated for 2020 to include 2 new codes; 66987 and 66988. These new codes reflect the use of endoscopic cyclophotocoagulation:

66982 (existing code) Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation

66987 … with endoscopic cyclophotocoagulation

66984 (existing code) Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation

66988 … with endoscopic cyclophotocoagulation