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

from
https://www.coronishealth.com/blog/code-changes-for-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:

1. 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.
2. 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.

Coronis Health 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 blood patch was a separate procedure from the labor & delivery.

Let’s Talk

from
https://www.coronishealth.com/blog/epidural-blood-patch-with-labor-delivery/

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 visits
• Virtual check-ins
• E-visits

Telehealth Visits

These are described as a provider-patient visit that uses audio or video telecommunication between the parties.  These are applicable for new or established patients. 

For commercial coverages, the appropriate CPT will be based on the content and length of the visit with the palette of existing office-visit codes now available for billing of these services (99201 – 99215).  Current guidance generally suggests that a telephone call is sufficient; however, best practice recommends using a professional grade combined audio and video product or service as the telecommunication protocol.

For Medicare coverages, these are described as visits conducted between a provider and a patient using two-way telecommunication systems with audio AND video capabilities. Office visit codes 99201 – 99215 should be used.   

Virtual Check-Ins

These are described as a brief 5 or 10-minute conversation initiated by the patient where a physician addresses a concern and decides whether an office visit or other service is needed for established patients only.  Generally, HCPCS codes G2012 or G2010 would be used for both Medicare and commercial coverages.

E-Visits

These are described as a communication between a patient and their provider through an on-line patient portal for established patients only.  Generally, HCPCS codes G2012 or G2010 would be used for both Medicare and commercial coverages.

Tips on Best Practice by Providers

For Medicare coverages, the “type of virtual communication” required to bill these services is audio & video combined.   This means using a professional Skype-like product that is HIPAA compliant.

For best-practice, we recommend all virtual visits be conducted and recorded using a professional-grade audio and video combined product or service.

from
https://www.coronishealth.com/blog/telehealth-visits-services/