Coding Tips

05/26/2020 – Reporting and capturing revenue for post-operative rounding

Question: How can we capture our work effort and optimize compensation for post-operative pain rounds? Answer: Post-operative pain rounding defined: a visit by the provider to the patient to assess their current condition. A pain round is not the same as a post anesthesia round. Post anesthesia rounding and the work effort involved is typically captured in the base units reported for the initial primary procedure for which anesthesia services were required.  Circumstance aside, there are times when the anesthesiologist may obtain separate payment for rounds for which the intent is to evaluate the effects of a separately billable postoperative pain procedure. To be considered a compensable patient encounter for which a round will be coded and reported for reimbursement, the following criterion must be met:Timing:  payment will be considered for a round performed the day after the procedure, and subsequent days if applicable. Classification:  There are two distin…

04/24/2020 – Telehealth Visits & Services

Question: What is considered Telehealth services?  Can we bill for these services now that carriers are loosening their requirements as a response to COVID-19? Answer: This entire area of telehealth services is an evolving topic amongst insurance carriers and information may change several times before final guidance emerges.  In the meantime, we can offer the following general guidance: For COVID-19 illness-related virtual visits, national guidance has emerged that governmental and commercial carriers will recognize and reimburse for telehealth services without copay or cost-sharing to the patient.  For all other virtual visits, several commercial carriers have published guidance in this area.  However, this may not be reflective of all commercial payors. General Organization of Telehealth Services Three main types of virtual visits or services have emerged under current guidance. These are as follows:  Telehealth visitsVirtual check-insE-…

03/25/2020 – Critical care billing tips

Critical care billing tips Question: We are being asked to provide critical care on COVID-19 patients. Is there any guidance you can offer as far as documentation requirements? Answer: Yes, please see the quick tips below for guidance. Codes Under 30 minutes, appropriate E & M code99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes99292 each additional 30 minutes (List separately in addition to code for primary service) Definition As per the CPT® guidelines, critical care (CC) is defined as the direct delivery by a physician of medical care for a critically ill or injured patient. A critical injury “acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient’s condition.” Time based codes Time must be documented in patients record and includes work directly related to the patients care, such as evaluatin…

02/25/2020 Epidural Blood Patch with Labor & Delivery

Question: Are epidural blood patches billable on the same day as labor & delivery? Answer: Administering a blood patch on the same day as labor and delivery is unusual because most physicians try to manage spinal headaches conservatively before turning to an invasive treatment. Double check a few things before billing the blood patch procedure: Ensure that what you call a blood patch wasn’t simply injecting blood through the epidural catheter before removing it after labor and delivery. If this is the case, you shouldn’t bill the injection separately. If you removed the epidural catheter after the delivery and determined later that day to administer an epidural blood patch, you can report it. Submit 62273 (Injection, epidural, of blood or clot patch) and include documentation of why the procedure was necessary. SupportMed will include the appropriate diagnosis code per your medical documentation and may need to add a billing modifier to indicate to the payor that the…

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 compute…