Anesthesia Coding Updates: New Cpt, Icd-10, And Modifier Changes

By Author: Albert
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In 2025, the anesthesia code will undergo major updates that will improve efficiency, accuracy, and consistency. A discussion of the key changes and their implications for anesthesia practitioners and medical coding services will be presented in this article. These updates are crucial for ensuring accurate medical billing and coding, minimizing claim denials, and optimizing revenue cycle management.
New Fascial Plane Block Codes
The introduction of new fascial plane block codes will be a major update in 2025. These codes streamline the reporting process and reduce the use of unlisted procedure codes, such as 64999. This clarity is essential for medical billing services to ensure claims are processed correctly. Here are the new codes:
64466: Thoracic fascial plane block, unilateral; by injection(s), including imaging guidance.
64467: Thoracic fascial plane block, unilateral; by continuous infusion(s), including imaging guidance.
64468: Thoracic fascial plane block, bilateral; by injection(s), including imaging guidance.
64469: Thoracic fascial plane block, bilateral; by continuous infusion(s), ...
... including imaging guidance.
64473: Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance.
64474: Lower extremity fascial plane block, unilateral; by continuous infusion(s), including imaging guidance.
Bundling of Imaging Guidance
A significant change for medical billing and coding services is the bundling of imaging guidance with the new fascial plane block codes. Imaging guidance is now inherently included in the codes, eliminating the need to report imaging separately. This alteration will improve efficiency and coding accuracy, making it easier for providers to document and bill these services.
CODING TIP:
Thoracic Blocks: Codes 64466–64469 for single-injection versus continuous infusion (e.g., ESP, serratus plane, PECS).
Lower Extremity Blocks: Codes 64473–64474 for fascia iliac, PENG, and IPACK blocks.
Existing abdominal block codes (64486–64489) now explicitly cover all abdominal fascial plane blocks.
The Reporting of Post-Cesarean Analgesia Blocks Separately (Billable in 2025)
As per NCCI 2025, epidural/peripheral nerve blocks may be billed separately for post-operative pain when the surgeon requests assistance and the block is not the anesthesia for the surgery. Medical billing and coding services should note that to ensure proper reimbursement, documentation must show the pain is post-operative, and modifier 59 or XU should be used.
Blocks of the abdominal fascial plane after C-section, such as TAP, rectus sheath, and QL, should be assigned 64486-64489. The 2025 guidance now covers codes for abdominal fascial plane blocks, including imaging if performed. However, under NCCI rules, these must still be reported separately.
Key Updates to CPT 01996
These updates have a direct impact on medical coding services and billing practices.
Not Billable on the Day of Catheter Insertion: CPT code 01996 is only reportable the day after the epidural or subarachnoid catheter is placed, not the day of insertion itself, as per CMS Molina Healthcare.
One Unit Per Postoperative Day: Only one unit of 01996 may be billed per day, regardless of how many visits or management activities. This is a crucial detail for accurate medical billing.
Limited to Three Postoperative Days—Then May Require Review: For example, Molina Healthcare policy states that 01996 is eligible for reimbursement for up to three days post-surgery; billing beyond that may initiate medical necessity review (with some exceptions, e.g., cancer-related pain).
Not Time-Based or Modifier-Driven: The CPT 01996 code is not a time-based anesthesia code and should not be billed using anesthesia time units or modifiers. According to UHC, it is excluded from standard anesthesia time-based billing for Providers. Similarly, WellCare explicitly notes it should not be submitted with time units in the quantity field Wellcare. The AANA also confirms that this code doesn’t require an anesthesia modifier.
Practical Implications for Coders & Providers
Day 1 (Insertion Day): Do not bill 01996.
Days 2–4 Post-Op: You may bill one unit per day for ongoing management.
Beyond Day 4: Additional documentation may be needed to support medical necessity, especially beyond 3 days.
Billing Method: Submit as a standalone procedural code—not time-based, and omit anesthesia-specific modifiers or units.
PROVIDER DOCUMENTATION TIPS FOR POST-OPERATIVE PAIN MANAGEMENT
Post-operative pain management is generally bundled into the surgeon’s global fee for the procedure. According to the Medicare NCCI Policy Manual, Chapter 2, the surgeon must document in the medical record the reason for referring this care to an anesthesia provider. While anesthesia practitioners have traditionally noted this request in their procedure notes, industry experts report that some payers are now expecting to see this documentation directly from the surgeon in the medical record. To ensure compliance and avoid issues during an audit or post-payment review, the best practice for medical billing services is to ensure the surgeon has recorded this request.
ICD-10-CM (Diagnosis Coding) Updates
Medical coding services will need to be well-versed in these new codes to ensure accurate claim submission.
New & Enhanced Pain Codes
G89.18: Other acute post-procedural pain has been clarified as the appropriate code for non-routine acute postoperative pain scenarios.
G89.12: Acute post-thoracotomy pain continues to be distinct for the chest surgery case.
G89.28: Other chronic post-procedural pain is the go-to code when postoperative pain transitions into a chronic condition.
Routine or expected postoperative pain should not be coded — only complicated or persistent pain warrants a G89 code.
Chronic Pain and Expanded Specificity
2025 brings enhanced granularity in coding various chronic pain conditions, enabling better accuracy:
G89.21: Chronic pain due to trauma.
G89.28: Other chronic post-procedural pain.
G89.29: Other chronic pain.
G89.4: Chronic pain syndrome.
G89.3: Neoplasm-related pain (acute or chronic).
G89.0: Central pain syndrome.
Providers must document pain duration and chronicity clearly to support code selection.
Additional codes address site-specific and neurological pain (e.g., various G90, G54, G56, M54 series) and behavioral/psychological factors affecting chronic pain (e.g., F45.42, F45.41).
For O24.1-, O24.3-, O24.8-, and O24.9- categories, there is now a “Use additional code” instruction for Z79.85 (injectable non-insulin diabetic drugs) when applicable.
ICD-10-PCS (Procedural) Updates – April 1, 2025
On April 1, 2025, CMS introduced new obstetrical procedure codes, which are vital for medical coding services:
0U7C7DJ: Dilation of cervix using a temporary intraluminal device via natural or artificial opening (e.g., balloon catheter, laminaria, Dilapan-S® rods) — to capture mechanical cervical ripening during labor induction.
Introduction of Modifier Changes
The year 2025 also introduces changes to modifiers used in anesthesia coding. These changes are intended to enhance clarity and accuracy in reporting anesthesia services. This is a critical area for medical billing services to get right to avoid denials. Some of the key modifier updates include:
Modifier 22: Increased procedural services. Use this modifier to indicate when the work required to provide a service is substantially greater than typically required.
Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day as the procedure or other service.
Modifier 59: Distinct procedural service. This modifier is applied to signify that a procedure or service is separate and distinct from other services carried out on the same day.

Read more: https://www.allzonems.com/anesthesia-coding-updates/