Anesthesia Coding 2019: Prep for Physician Fee Schedule, Review EGD Procedure Codes

CPT: While waiting for January 1, catch up on what you’ve missed for 2018

If you’re like most anesthesia coders, you’re so busy with the day-to-day that you don’t have the time (or the support) to get up to speed on all the code changes coming your way. But nothing would make you happier than to see your claims denial rates drop!

In her 90-minute live webinar on anesthesiology coding and billing updates, consultant Kelly Dennis swiftly walks you through the important points of what’s new for 2019 and how to catch up on what you may have missed for 2018. The good news is there aren’t too many anesthesia CPT® coding updates for 2019. On the other hand, there were plenty in 2018 that you may still be adjusting too, especially those related to esophagogastroduodenoscopy (EGD) procedures codes.

Here’s a quick rundown of the codes you’ll want to have a firm grasp of as you look ahead to 2019:

5 Added GI Codes

Five codes were added in 2018: Two for upper gastrointestinal (GI) endoscopic procedures, two for lower intestinal endoscopic procedures, and one for combined upper/lower GI procedures.

Anesthesia for upper GI endoscopic procedures, endoscope introduced proximal to duodenum

Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum

  • 00811, not otherwise specified
  • 00812, screening colonoscopy

Anesthesia for combined upper and lower GI endoscopic procedures

  • 00813, endoscope introduced both proximal to and distal to the duodenum

Check your work: You must have a thorough understanding of all the procedures classified within the above codes to avoid over- or under-billing. Don’t assume that since a new code has similar wording to an old one that it contains all the same services!

EGD procedure codes: Keep in mind that EGD procedures are done so the physician can examine the upper GI tract. That means they’re looking at the esophagus lining, stomach, and duodenum (upper part of the small intestine). So if the documentation mentions an EGD procedure—sometimes called an “upper endoscopy”—using 00813 is possible, 00731 and 00732 are likely, but you’ll want to stay away from 00811 and 00812.

5 Deleted GI Codes

You were also able to forget about five delete codes in 2018. Hopefully you haven’t been using them this year, but, in case you’ve been wondering about those denied claims, here are the codes you should no longer be using:

  • 00740, Anesthesia for upper GI endoscopic procedures, endoscope proximal to duodenum
  • 00810, Anesthesia for lower GI endoscopic procedures, endoscope distal to duodenum

If you feel like you just read the same thing twice, you’re sort of right. Codes 00740 and 00810 are very similar to new codes 00731 and 00811 with just a slight change in the wording. If needed, keep a cheat sheet for handy reference to avoid slipping back into using those old codes.

Note: This year, you should also have stopped using these three deleted anesthesiology codes: 01180—Anesthesia for obturator neurectomy, extrapelvic;  01190—Anesthesia for obturator neurectomy, intrapelvic; and 01682—Anesthesia for shoulder cast application, removal or repair, shoulder spica.

Keep Watch on the 2019 Proposed Fee Schedule

With all this talk of 2018 changes, you’re surely eager to know what to expect for 2019. The biggest change to prepare for is the 2019 Physician Fee Schedule, set to take effect on January 1, 2019—the same day the new CPT® codes are to be implemented. The final version should be issued in the next month or so, but for now take a look at the proposal here.

The Centers for Medicare & Medicaid Services has also created a fact sheet to help break down the rule’s possible effects. This rule would, among other things, affect relative value units (RVUs) for anesthesiology, as well as make changes to the national conversion factor (CF) for anesthesia services.

And be sure to tune in to Dennis’s webinar, where she’ll discuss all the latest updates for 2019 anesthesia coding.

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