Pain management cpt codes 62310, 62319, 64415 - 64449

Pain Management - Anesthesia

Pain Management Consultation

Evaluation and management services for postoperative pain control on the day of surgery are considered part of the usual anesthetic services and are not separately reportable. When medically necessary and requested by the attending physician, hospital visits or consultative services are reportable by the anesthesiologist during the postoperative period. However, normal postoperative pain management, including management of intravenous patient controlled analgesia, is considered part of the surgical global package and should not be separately reported.

Postoperative Pain Control Procedures

When provided principally for postoperative pain control, peripheral nerve injections and neuraxial (spinal, epidural) injections can be separately reported on the day of surgery using the appropriate CPT procedure with modifier -59 (Distinct Procedural Service) and 1 unit of service. Examples of such procedures include:

62310-62319           Epidural or subarchnoid injections
64415-64416           Brachial plexus injection, single or continuous
64445-64448           Sciatic or femoral injections, single or continuous
64449                       Lumbar plexus injections, continuous

These services should not be reported on the day of surgery if they constitute the surgical anesthetic technique.

NOTE: Modifier 59 requires that the medical record substantiate that the procedure or service was a distinct or separate services performed on the same day.

Daily Management of Continuous Pain Control Techniques

Daily hospital management of continuous epidural or subarachnoid drug administration is reported using CPT code 01996 (1 unit of service daily). This code may be reported on the first and subsequent postoperative days as medically necessary.

When continuous block codes 64416, 64446, 64448, or 64449 are reported on the day of surgery, no additional reporting of daily management is permitted during the following ten days (10 day global period). When these injections procedures constitute the main surgical anesthetic and are therefore not separately reported on the day of surgery, subsequent days’ hospital management is reported using the appropriate hospital visit code (99231-99233).

Anesthesia cpt code procedure qualifiying factor and description units.

Procedure Codes and Modifiers

Anesthesia providers are required to utilize the appropriate anesthesia code
identified in the current Relative Value Guide published by the American
Society of Anesthesiologists. Time in attendance should be billed by listing
total minutes

HP will calculate total units by dividing the total minutes (reported in block
24G) by 15, rounding up to the next whole number, and adding the time units
to the auto-loaded base unit values. The base unit values are derived from
the ASARVG for CPT-4 anesthesia codes.

of anesthesia time in block 24G of the CMS-1500 claim form.
Type of service “7” should be used for billing anesthesia codes (00100-
01997). The (837) Institutional electronic claim and the paper claim have
been modified to accept up to four Procedure Code Modifiers. Effective
October 1, 2004 to bill for code 90784, bill the first line item with the code and
one unit. Bill the second line item with code 90784 with modifier 76 (repeat
procedure) and 3 units.

The number of qualifying factor units is multiplied by the price allowed for
anesthesia services. For more information regarding qualifying factors, see
the next section of this manual.

Qualifying Factors
Beginning June 14, 2002, qualifying factors will be reimbursable. Qualifying
factors allow for anesthesia services provided under complicated situations
depending on irregular factors (ex: abnormal risk factors, significant operative
conditions). The qualifying procedures would be reported in conjunction with
the anesthesia procedure code on a separate line item using 1 unit of service.
The qualifying procedure codes are indicated below.

Procedure Code Description Units
99100 Anesthesia for recipient with farthest ages, over
seventy and under one year 1
99116 Complication of anesthesia by utilization of total
body hypothermia 1
99135 Complication of anesthesia by utilization of
controlled hypotension 1
99140 Complication of anesthesia by emergency
conditions 1

Biling and coding tip for anesthesia CPT codes

CPT Anesthesia Code List

00100–00222 Head

00100 Anesthesia for procedures on salivary

glands, including biopsy

00102 Anesthesia for procedures on plastic

repair of cleft lip

Coding Tip

Do not use code 00102 for procedures performed on

the lip for conditions other than repair of cleft lip. For

other, non-cleft lip repairs, see code 00300.

For cleft palate repairs, see 00172.

00103 Anesthesia for reconstructive procedures

of eyelid (eg, blepharoplasty, ptosis

surgery)

00104 Anesthesia for electroconvulsive therapy

Coding Tip

Code 00104 may be denied when multiple electroconvulsive therapy (ECT) is provided. ECT (CPT code 90871) is a noncovered service by Medicare. Therefore, when anesthesia is performed for this reason, it will be denied as such.

00120 Anesthesia for procedures on external, middle, and inner ear including biopsy; not otherwise specified

00124 otoscopy

00126 tympanotomy

Coding Tip

Codes 00120–00126 each identify a unilateral service. If the surgeon performs bilateral surgical services, use modifier 50 (bilateral procedure).

00140 Anesthesia for procedures on eye; not otherwise specified

00142 lens surgery

00144 corneal transplant

Coding Tip

Codes 00140–00144 each identify a unilateral service. If the surgeon performs bilateral surgical services, use modifier 50 (bilateral procedure).

00145 Anesthesia for procedures on eye; vitreoretinal surgery

Coding Tip

Code 00145 is for a unilateral service. If the surgeon performs bilateral surgical services, use modifier 50 (bilateral procedure).

This code is appropriate to use on any vitreoretinal procedures requiring the same anesthetic management.

00160 Anesthesia for procedures on nose and accessory sinuses; not otherwise specified

00162 radical surgery

00164 biopsy, soft tissue

00170 Anesthesia for intraoral procedures, including biopsy; not otherwise specified

Coding Tip:

Diagnosis coding is important to substantiate coverage of code 00170.

Anesthesia provided in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth is

noncovered by Medicare.

J codes J0120–J9999 Drugs Administered Including Oral and Chemotherapy Drugs

K codes K0001–K9999 Durable Medical Equipment Prosthetics, Orthotics, Supplies and Dressings (DMEPOS)

L codes L0100–L9999 Orthotic and Prosthetic Procedures, Devices

M codes M0064–M9999 Medical Services

P codes P2028–P9999 Pathology and Laboratory Services

Q codes Q0035–Q9999 Miscellaneous Services

(Temporary Codes)

R codes R0070–R9999 Radiology Services

T codes T1000–T9999 Medical Services

S codes S0009–S9999 Commercial Payers (Temporary

Codes)

V codes V2020–V9999 Vision, Hearing and Speech-

Language Pathology Services

Radiologic Anesthesia Coding

In keeping with standard anesthesia billing guidelines for Medicare, only one anesthesia code may be reported for anesthesia services provided in conjunction with radiological procedures. Radiological Supervision and Interpretation (S & I) codes will usually be applicable to radiological procedures
being performed.

The appropriate S & I code may be reported by the appropriate provider (radiologist, cardiologist, neurosurgeon, radiation oncologist, etc.). Accordingly, S & I codes are not included in anesthesia codes referable to these procedures; only the appropriate provider, however, may bill for S & I services. CPT code 01920 (Anesthesia for cardiac catheterization including coronary angiography and ventriculography (not to include Swan- Ganz catheter) can be reported for monitored anesthesia care (MAC) in patients who are critically ill or critically unstable.

If the physician performing the radiologic service places a catheter as part of that service, and, through the same site, a catheter is left and used for monitoring purposes, it is inappropriate for either the anesthesiologist/certified
registered nurse anesthetist or the physician performing the radiologic procedure to bill for placement of the monitoring catheter (e.g., CPT codes 36500, 36555-36556, 36568-36569, 36580, 36584, 36597).

Anesthesia with Manipulation CPT codes

 CPT Codes:

21073     Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care)
22505     Manipulation of spine requiring anesthesia, any region
23700     Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)
24300     Manipulation, elbow, under anesthesia
25259     Manipulation, wrist, under anesthesia
26340     Manipulation, finger joint, under anesthesia, each joint
27194     Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; with manipulation, requiring more than local anesthesia
27275     Manipulation, hip joint, requiring general anesthesia
27570     Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices)
27860     Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus)

Proven Diagnosis Codes:

718.51     Ankylosis of joint of shoulder region
718.52     Ankylosis of upper arm joint
718.56     Ankylosis of lower leg joint
726.0     Adhesive capsulitis of shoulder
733.19     Pathologic fracture of other specified site
805.6     Closed fracture of sacrum and coccyx without mention of spinal cord injury
806.61     Closed fracture of sacrum and coccyx with complete cauda equina lesion
806.62     Closed fracture of sacrum and coccyx with other cauda equina injury
806.79     Open fracture of sacrum and coccyx with other spinal cord injury
808.0     Closed fracture of acetabulum
808.2     Closed fracture of pubis
808.41     Closed fracture of ilium
808.42     Closed fracture of ischium
808.43     Multiple closed pelvic fractures with disruption of pelvic circle
808.49     Closed fracture of other specified part of pelvis
812.4     Closed fracture of lower end of humerus (Incomplete code - additional digit required)
813.01     Closed fracture of olecranon process of ulna
839.41     Closed dislocation, coccyx
839.42     Closed dislocation, sacrum
839.69     Closed dislocation, other location
V43.65     Knee joint replacement by other means

Unproven Diagnosis Codes:

524.60     Unspecified temporomandibular joint disorders
524.69     Other specified temporomandibular joint disorders
718.25     Pathological dislocation of pelvic region and thigh joint
718.54     Ankylosis of hand joint
718.55     Ankylosis of pelvic region and thigh joint
718.57     Ankylosis of ankle and foot joint
808.43     Multiple closed pelvic fractures with disruption of pelvic circle