Of the many coding changes introduced in 2013, only a few have a direct impact on pain management and anesthesia services. For all time-based code, CPT 2013 defines "time" as "face-to-face time with the patient" unless the code itself or an instruction related to the code range contains the opposite specific instruction. Anesthesia codes do not fall into these ranges; references are code that is based on the amount of time required to perform the service. A time unit can be obtained from the midpoint. In the case where another service is executed concurrently with the time-based service, the time associated with the concurrent service must not be included in the time for reporting the time-based service.

CPT also introduced the term qualified health care professional [QHP] and provided instructions for its use throughout the CPT codebook. QHP is defined as an individual who “qualifies through education, training, licensing/regulation [where applicable] and the implementation of professional services within its practice and independently reports the facility privileges [where applicable] of the professional service.” Qualified Health Care Professional Personnel should be distinguished from clinical staff. Clinical staff are people who work under the supervision of a doctor or other qualified health care professional. Laws, regulations, and facility policies allow them to perform or assist in the execution of specific professional services, but they cannot be reported separately.

No revisions were made in 2013 to remove or add an anesthesia code.

Here are some coding changes, revisions, and deletions that are of interest to pain management professionals.

New specification for complex chronic disease care coordination services

• 99487 Complex chronic care care coordination service; first calendar of clinical staff time per month, guided by a doctor or other qualified health care professional, without face-to-face interviews
• 99488 Complex Chronic Care Coordination Service; first hour clinical staff time for face-to-face interviews by doctors or other qualified health care professionals in each calendar month
• 99489 Complex chronic care care coordination service; additional 30 minutes of clinical staff time per month, guided by a doctor or other qualified health care professional [except for the main program code]

These new specifications enable doctors, other qualified health care professionals, and clinical staff to spend time in coordinating the various services and medical professions required to manage the patient's health, daily activities, and the complexities of psychosocial needs. They include all non-face-to-face care coordination services and may include a face-to-face office/outpatient/family/family assessment and management visit related to the patient's chronic patient care plan.

Another important thing to note is that these codes can only be reported once per calendar month. They also cannot be reported along with the exclusion code for the same month of medicine and E/M. These providers must clearly understand the guidelines for using these new codes.

For 2013, Medicare treats these three codes as bundled services and does not compensate them. According to the CMS, the services represented by these codes are properly bundled in the services they occur and cannot be paid separately. Codes 99487, 99488 and 99489 have been assigned a status indicator B [payments covering the service are always bundled into payments for other services] and are temporarily used for 2013. However, CMS intends to consider the code for complex care coordination services as part of the general case. Strategies to support primary care and care management. It also plans to explore ways to promote primary care in a pay-as-you-go payment structure.

Changes in the annotations of the nervous system

• Neurostimulator [peripheral nerve]from

  : Revised in CPT code 64561 to indicate that the code contains image guidance and should not be reported separately. The code description is "percutaneously implanted neurostimulator electrode array; the phrenic nerve includes image guidance, if performed."

• Neurolysis agents [eg chemical, thermal, electrical or radio frequency], destruction of chemical denervationfrom

  : In this section, the introductory guide and title have been revised to include chemodenervation. The added brackets indicate the encoding of a particular chemical denervation process. It is also stated that chemical denervating agents must be reported separately.

The revised code is:

• 64612 Muscle chemical denervation; muscles innervated by facial nerves, unilateral [eg, eyelids, hemifacial spasm]; to report bilateral procedures, use modifier 50.

• 64614 Chemical denervation of the muscles; limbs and / or trunk [such as dystonia, cerebral palsy, multiple sclerosis [report only once]

The new code in this section is:

• 64615 Muscle chemical denervation; muscles dominated by the face, trigeminal, cervical and accessory nerves, bilateral [eg chronic migraine] [reported only once per report, not reported with 64612-64614]

Other new specifications

• 95907-95913: In 2013 these new nerve conduction test codes were used to indicate the number of studies performed, not each nerve, as a service unit.

• 95907 for 1-2 studies; 95908 for 3-4 studies; 95909 for 5-6 studies; 95910 for 7-8 studies; 95911 for 9-10 studies, 95912 for 11- 12 studies; 95913 for 13 or more studies.

Code for neurophysiological monitoring inside and outside the operating room

• +95940: Continuous IONM [intraoperative neurophysiological monitoring] in one-to-one monitoring of OR requires personal attendance, 15 minutes each time

• +95941: Continuous IONM from the outside of the OR [remote or nearby] or >1 case per hour in the OR. [This code cannot be reimbursed by CMS. The G code [G0453] has been created and is divided into 15-minute increments to allow the monitoring physician to provide one-time attention to one patient. The start/stop time must be accurately recorded.]

+95940 is only used to report when the monitoring personnel actually appear in the OR; no other cases can be monitored simultaneously. +95941 is used to report all cases in which the monitoring professional did not actually appear in the OR during the monitoring period; or to monitor multiple cases when actually present in the OR.

Deleted code

• Nerve conduction test codes 95900, 95903 and 95904 have been removed.
• Intraoperative neurophysiology +95920 has been removed.

Other interesting revisions in the code

• 76942: Ultrasound guidance of needle placement [eg biopsy, aspiration, injection, positioning device], imaging supervision and interpretation. This code should not be reported with 27096, 32555, 32555, 35556, 32557, 37760, 37761, 43232, 43237, 43224, 45341, 45342, 64479-64484, 64490-64495, 76975, 213T-0218T, 0228T-0231T, 0232T , 0249T, 0301T

• 64561: Percutaneously implanted nerve stimulator electrode array: phrenic nerve [placed through the intervertebral foramen], including image guidance, if performed

Update on pain management and anesthesia professionals in 2013 was originally published on Spring