# CANPC Anesthesiology coding essentials book 62 p. (20-45)



## vinomodyjr (Apr 10, 2017)

CANPC Anesthesiology coding essentials for successful anesthesiology coding by Vino C. Mody Jr., M.D., COC, CPC, CCS-P, CANPC, CCVTC
Case 20
Anesthesiologist personally provided the anesthesiology for the case
Anesthesia: General endotracheal
PS III
The patient is a 75 year old patient with cancer of the anterior wall of the bladder.
Diagnosis: Maiignant neoplasm of the anterior wall of the bladder, 2.5 cm in diameter size
Procedure: Cystourethroscopy with fulguration (including cryosurgery or laser surgery) and/or resection of MEDIUM bladder tumor(s)(2.0 to 5.0 cm)
Codes
C67.3, 52235
ASA Crosswalk Lookup
52235=5 base value units=00912
Overall anesthesiology code for the billing anesthesiologist
00912-AA-P3
Clinical viewpoint
The patient undergoes Cystourethroscopy with resection of a MEDIUM bladder tumor of the anterior wall. The patient has severe systemic disease or cancer (PS III). The patient has a qualifying circumstance, or extreme age greater than seventy.
Case 21
Anesthesiologist provided the anesthesiology for the case
Anesthesia: General endotracheal
PS III
The patient is a 65 year old male with basal cell carcinoma of the cheek of the face measuring 2.6 cm in diameter and a malignant neoplasm of the right upper arm measuring 3.5 cm in diameter. He presents for excision of both tumors and simple repair.
Diagnoses: Basal cell carcinoma of the cheek of the face, 2.6 cm; Malignant neoplasm of the right upper limb, 3.5 cm
Procedures: Excision of basal cell carcinoma of the cheek of the face, excised diameter 2.6 cm; Excision malignant lesion of the upper limb, excised diameter 3.5 cm; Simple repair of superficial wound of extremities, 3.5 cm; simple repair of superficial wound of face, 2.6 cm
Codes
C44.319, C76.41 11643, 11604, 12013, 12002-59
ASA Crosswalk Lookup
11643=5 base value units=00300
11604=3 base value units=00400
12013=5 base value units=00300
12002=5 base value units=00300
Overall anesthesia code for the billing anesthesiologist
00300-AA-P3
00300 Anesthesia for all procedures on the integumentary system, muscles and nerves of the head, neck, and posterior trunk, not otherwise specified
Clinical viewpoint
The patient has basal cell carcinoma of the face and a malignant neoplasm of the upper limb. The procedures performed were excision of both malignant tumors and simple repairs. The patient has severe systemic disease (PS III). There was a three-way tie in anesthesiology coding, yet all three CPT codes yielded the same anesthesia code (00300). The anesthesia code with the highest base unit value is the overall anesthesia code for the case.
Case 22
Anesthesiologist provided the anesthesiology for the case
Anesthesia: General endotracheal
PS III
Pt. with a diagnosis of right renal cyst is scheduled to undergo sclerosis of the cyst. Sinogram through existing drainage tube was performed.
Diagnosis: Renal cyst, right
Procedures: Injection of sinus tract; Radiologic examination, sinus tract study; radiological supervision and interpretation
Codes
N28.1, 20500, 76080
ASA Crosswalk Lookup
20500=3 base value units=00400
76080=Not in ASA Crosswalk
Overall anesthesiology code for the billing anesthesiologist
00400-AA, P3
Clinical viewpoint
The sinus tract study is a radiological examination not requiring anesthesia. The injection of sinus tract for sclerosis of the renal cyst is coded and determines an anesthesia code. The renal cyst is a severe systemic disease.
Case 23
Anesthesiologist personally provided the anesthesiology for the case
Anesthesia: General endotracheal
PS III
The pt. has an abdominal hernia causing obstruction and presents for hernia repair.
Diagnosis: Abdominal ventral hernia causing obstruction; incarcerated
Procedures: Abdominoplasty; Abdominal wall plication for ventral hernia repair
Codes
K46.0, 15830, 49653
ASA Crosswalk Lookup
15830=5 base value units=00802
49653=6 base value units=00752
Overall anesthesiology code for the case for the billing anesthesiologist
00752-AA-P3
Clinical viewpoint
The higher base value units for anesthesia code 00752 makes 00752 the overall anesthesiology code for the case
Case 24
Anesthesiologist personally provided the anesthesia for the case
Anesthesia: General endotracheal
PS III
The pt. is a 55 year old male who presents with ventricular tachycardia. He undergoes ablation with Impella-R support.
Diagnosis: Ventricular tachycardia
Procedure: Intracardiac catheter ablation of arrhythmogenic focus with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping
Codes
I47.2, 93654
ASA Crosswalk Lookup
93654=10 base value units=00537
Overall anesthesiology code for the case for the billing anesthesiologist
00537-AA-P3
Clinical viewpoint
The pt. has ventricular tachycardia requiring intracatheter ablation of an arrhythmogenic focus with treatment of ventricular tachycardia. The anesthesia for electrophysiologic procedures including radiofrequency ablation is performed.
Case 25
Anesthesiologist personally provided the anesthesiology for the case
Anesthesia: General endotracheal
PS III
Pt. is a 50 year old female who has severe abdominal pain and undergoes surgery for splenic hemorrhage. Accidental perforation of colonic splenic flexure occurring during surgery.
Diagnosis: Accidental perforation of colonic splenic flexure during surgery with emergency bleeding
Procedure: Laparoscopy procedure, spleen
Codes
K63.1, T81.718A, 38129
ASA Crosswalk Lookup
38129=unlisted procedure=7 base value units=00790
Overall anesthesiology code for the case for the billing anesthesiologist
00790-AA-P3,
+99140
Clinical viewpoint
This patient has an accidental perforation of colonic splenic flexure. Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified is performed. Anesthesia complicated by emergency conditions (specify) which was the emergency bleeding for the case was performed (+99140) and scores two base value units in the units calculation.
Case 26
Anesthesiologist provided general endotracheal anesthesia for the case. A 25 year old normal healthy patient (P I) has a one inch by one inch second degree burn on his face. He received Acellular dermal replacement graft such as Integra for his face.
Codes
T20.20XA, T31.0, 15275
ASA Crosswalk Lookup
15275=5 base value units=00300
Overall anesthesiology code for the billing anesthesiologist
00300-AA-P1
Clinical viewpoint
The patient has a second-degree burn which is less than 10% of total body surface on his face which requires an Acellular dermal replacement graft such as Integra to replace the dermis. A second-degree burn penetrates into the epidermis and dermis. The anesthesia is for procedures on the integumentary system, muscle and nerves of head, neck, and posterior trunk, not otherwise specified (00300). In this case there is one CPT code corresponding to the correct anesthesiology code for the case.
Case 27
Anesthesiologist personally performed the general endotracheal anesthesia for the case. The patient is a normal healthy patient who is having neurostimulator and leads placed percutaneously for chronic back pain, which he has had for two years in an ambulatory surgery care center. During surgery, the placement of the neurostimulator leads was aborted. 
Codes 
G89.29, 63688, 63650-74
ASA Crosswalk Lookup
63688=3 base value units=00400
63650=5 base units value=01936
Overall anesthesiology code for the case for the billing anesthesiologist
01936-AA-P1
Clinical viewpoint
This patient has a discontinued procedure for percutaneous implantation of neurostimulator electrodes, plate/paddle, epidural (63650-74) for which the neurostimulator pulse generator was removed (63688). The anesthesiology was 01936 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic. The higher base units value (=5) for 01936 makes 01936 the overall anesthesiology code for the case. This case is both anesthesiology and pain management, and illustrates the placement of neurostimulator leads for chronic pain from the spinal cord and brain. The neurostimulator is placed under the skin of the abdomen, and the neurostimulator leads give electronic signals to the epidural space near the spinal cord. 
Case 28
Anesthesiologist personally directed the general endotracheal anesthesia for the case. The patient is a normal healthy 27 year old female who has a VEPTR from a baseball injury five years ago when he had an acquired deformity who presents for adjustment of VEPTR lengthening mechanism. VEPTR stands for Vertical expandable prosthetic titanium rib. 
Codes
M95.4, Z45.89, 21899
ASA Crosswalk Lookup
21899=unlisted code
00470-AA-P1 Anesthesia for partial rib resection; not otherwise specified
Clinical viewpoint
When the CPT code looked up in ASA Crosswalk is unlisted, do your best to find an appropriate anesthesiology code based on the descriptions in CPT. The patient presented for an adjustment of VEPTR (Z45.89) which was placed for an acquired deformity of the rib (M95.4) from a baseball injury.
Case 29
Anesthesiologist personally provided the general endotracheal anesthesia for the case. The patient is a gastrointestinal disorder patient with a percutaneous endoscopic gastrostomy (PEG) tube placed for nutrition. He undergoes esophagogastroduodenscopy (EGD) and PEG removal.
K92.9, 43235, 43760
ASA Crosswalk Lookup
43235=5 base value units=00740
43760=4 base value units=00700
Overall anesthesiology code for the case for the billing anesthesiologist
00740-AA-P3
Clinical viewpoint
The patient has severe systemic disease, i.e., a gastrointestinal disorder (P3) and the anesthesia was anesthesia for upper gastrointestinal endoscopic procedures.
Case 30
Anesthesiologist personally directed the general endotracheal anesthesia for the case. A normal healthy 35 year old male patient had back pain for one year. He received an MRI which showed L4-L5 lateral foraminal stenosis and underwent L4-L5 Laminectomy, facetectomy, and foraminotomy with decompression of spinal cord.
Codes
M99.73, 63047
ASA Crosswalk Lookup
63047=8 base value units=00630
Overall anesthesiology code for the case for the billing anesthesiologist
00630-AA-P1
Clinical viewpoint
The anesthesia is anesthesia for procedures in the lumbar region. The case is both anesthesiology and pain management. In this case, surgery was required to treat the foraminal stenosis which caused the back pain after medication pain management was successful only to a degree.
Case 31
Anesthesiologist provided the general endotracheal anesthesia for the case. A normal healthy patient (PS I) complains of right upper quadrant pain. A CT scan shows Acute cholecystitis. A laparoscopic surgical cholecystectomy is performed.
Codes
K81.0, 47562
ASA Crosswalk Lookup
47562=7 base value units=00790
Overall anesthesiology code for the case for the billing anesthesiologist
00790-AA-P1
Clinical viewpoint
The patient underwent a laparoscopic surgical cholecystectomy under Anesthesia for procedures in upper abdomen including laparoscopy (00790).
Case 32
Anesthesiologist provided the general endotracheal anesthesia for the case. A normal healthy patient (PS I) complains of right upper quadrant pain for two years. A CT scan shows chronic cholecystitits. An open cholecystectomy is performed.
Codes
K81.1, 47600
ASA Crosswalk Lookup
47600=7 base value units=00790
Overall anesthesiology code for the billing anesthesiologist
00790-AA-P1
Clinical viewpoint
The anesthesia is for anesthesia for intraperitoneal procedures in upper abdomen. The procedure was an open procedure. The gall bladder is located in the right upper quadrant.
Case 33
Anesthesiologist personally directed the general endotracheal anesthesia for the case. A 50 year old male patient has had difficulty swallowing and gastroesophageal reflux disease for two years (PS III). He is found on MRI to have weakness of the lower esophageal sphincter. He undergoes laparoscopic augmentation of the lower esophageal sphincter with a magnetic device (e.g., LINX Reflux Management System).
Codes
K21.9, 43289
ASA Crosswalk Lookup
43289=unlisted code=7 base value units=00500
Overall anesthesiology code for the case for the billing anesthesiologist
00500-AA-P3
Clinical viewpoint
The anesthesia was for procedures on esophagus. In this case, the CPT code was for an unlisted procedure and therefore not listed in ASA Crosswalk.
Case 34
Anesthesiologist provided the general endotracheal anesthesia for the case. The patient is a 50 year old female with atherosclerosis (PS III) of her left anterior descending coronary artery on angiogram. Percutaneous transluminal angioplasty, atherectomy, and stent insertion was performed on the left anterior descending coronary artery. 
Codes
I25.10, 92933-LD 
ASA Crosswalk Lookup
92933=8 base value units=01925
Overall anesthesiology code for the case
01925-AA-P3
Clinical viewpoint
The patient has three cardiovascular procedures performed on the same branch (LAD) of the left coronary artery, percutaneous transluminal angioplasty, atherectomy, and stent insertion. One CPT code (92933-LD) accounts for all three procedures performed on the same vessel. Anesthesia for therapeutic interventional radiological procedures involving the arterial system; carotid or coronary is performed (01925).
Case 35
Anesthesiologist personally directed the monitored anesthesia care for the case. The patient is a 45 year old male with osteoarthritis (PS III) who sustained a displaced bimalleolar right ankle fracture from an automobile accident two years ago. He underwent open treatment for the fracture involving the placement of hardware. Today, he presents with ankle pain from osteoarthritis. He undergoes arthrodesis of the ankle (ankle fusion), osteotomy, and removal of hardware. 
Codes
M19.071, M25.571, Z87.81, 27870, 27705, 27704
ASA Crosswalk Lookup
27870=3 base value units=01480
27705=4 base value units=01484
27704=3 base value units=01480
Overall anesthesiology code for the billing anesthesiologist
01484-AA-QS-P3
Clinical viewpoint
The patient underwent open arthrodesis of the ankle (27870), osteotomy of tibia (27705), and removal of ankle implant (hardware) (27704) for ankle pain secondary to osteoarthritis. The patient has a personal history of a healed ankle fracture (Z87.81). In ASA Crosswalk Lookup, because 01484 is 4 base value units, higher than the other two codes, the overall anesthesiology for the case is 01484. The anesthesia is for open procedures on bones of lower leg, ankle, and foot; osteotomy or osteoplasty of tibia and/or fibula.
Case 36
Anesthesiologist provided the general endotracheal anesthesia for the case. A 25 year old male patient has epilepsy (PS IV), not intractable without status eplilepticus. He undergoes amygdalohippocampectomy by sterotactic method for subcortical structures.
Codes
G40.909, 61735
ASA Crosswalk Lookup
61566=11 base value units=00210
Overall anesthesiology code for the case for the billing anesthesiologist
00210-AA-P4
Clinical viewpoint
The patient undergoes selective amygdalohippocampectomy (61566) for epilepsy (G40.909), a severe systemic disease that is a constant threat to life (PS IV). Anesthesia is for intracranial procedures, not otherwise specified (00210). 
Case 37
Anesthesiologist provided the general endotracheal anesthesia including cardiopulmonary bypass (PS III) for the case. A 38 year old female complains of palpitations. On physical exam, the doctor finds a heart murmur. Transthoracic echocardiogram shows mitral valve stenosis. The patient undergoes valvuloplasty, mitral valve, with cardiopulmonary bypass, with Carpentier prosthetic ring.
Codes
I34.2, 33426
ASA Crosswalk Lookup
33426=20 base value units=00562
Overall anesthesiology code for the case for the billing anesthesiologist
00562-AA-P3
Clinical viewpoint
The patient has a heart murmur secondary to mitral valve stenosis (I34.2) according to echocardiogram. The patient undergoes valvuloplasty of the mitral valve with cardiopulmonary bypass with a prosthetic ring (33426).  The anesthesia is for procedures on heart, pericardial sac, and great vessels of chest; with pump (00562). The case was an intense case as it required cardiopulmonary bypass and therefore general endotracheal anesthesia was required.
Case 38
Anesthesiologist personally provided the general endotracheal anesthesia for case (PS III). A 60 year old female patient with generalized osteoarthritis has had neck and back pain for two years. MRI reveals cervical disc displacement. The patient undergoes anterior C7-T1 cervical thoracic fusion with total discectomy. 
Codes
M50.20, M15.0, 22556, 22222
ASA Crosswalk Lookup
22556=15 base value units=00626
22222=15 base value units=00626
Overall anesthesiology code for the billing anesthesiologist
00626-AA-P3
Clinical viewpoint
The patient has cervical disc displacement (M50.20) requiring arthrodesis with anterior interbody technique including minimal discectomy to prepare to prepare interspace (22556) and Osteotomy of spine including discectomy (22222). In this case, there is a split tie in anesthesiology coding but it makes no difference since the generated anesthesiology code (00626) is the same for both procedure codes.    

Case 39
Anesthesiologist provided the monitored anesthesia care (MAC) for the case (PS I). A 27 year old female in the second trimester of pregnancy presents for maternal care to the OB-GYN doctor. The OB-GYN doctor finds a retroversion of gravid uterus on physical exam and ultrasound. The patient undergoes surgery for Anteversion of retroverted uterus.  
Codes
O34.532, 58540
ASA Crosswalk Lookup
58540=6 base units value=00840
Overall anesthesiology code for the case for the billing anesthesiologist
00840-AA-QS-P1
Clinical viewpoint
The anesthesia is for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified (00840). The OB-GYN case involved intraperitoneal surgery on the lower abdomen. The surgery was hysteroplasty, repair of uterine anomaly.

Case 40
Anesthesiologist personally provided the general endotracheal anesthesia for the case. A healthy 25 year old patient (P1) becomes burned in the chest wall while removing hot food from the oven. The second-degree partial thickness burn covers approximately 3.5% of total body surface area. The burn is debrided in the operating room with a dressing placed post-operatively.
Codes
T21.21XA, T31.0, X10.1XXA, Y93.G3, 16020
ASA Crosswalk Lookup
16020=3 base value units=01951
Overall anesthesiology code for the billing anesthesiologist
01951-AA-P1
Clinical viewpoint
The patient has a second-degree burn extending partial-thickness into the dermis which is debrided in the operating room with a dressing placed post-operatively. The anesthesia is for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (TBSA) treated during anesthesia and surgery; less than 4% total body surface area (01951). 
Case 41
Anesthesiologist personally provided the general endotracheal anesthesia for the case (PS III). A 6 month old female has a congenital malformation of the aorta. She has a murmur on cardiac exam and is found to have aortic valve insufficiency, non-rheumatic on transthoracic echocardiogram. The patient undergoes aortic root replacement with thoracic aorta replacement. 
Codes
Q25.40, I35.1, 33863
ASA Crosswalk Lookup
33863=25 base unit value=00561
Overall anesthesiology code for the case for the billing anesthesiologist
00561-AA-P3
Clinical viewpoint
The anesthesia is for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age (00561). The patient has a congenital malformation of the aorta requiring surgery (33863).
Case 42
Anesthesiologist personally provided the general endotracheal anesthesia for the case (PS III). The patient is a 56 year old male with multiple medical problems: atherosclerosis of the aorta, chronic constrictive pericarditis, and an acquired cardiac septal defect. The patient undergoes aortic valve surgery with excision of calcium deposits. He undergoes resection or incision of subvalvular tissue for discrete subvalvular aortic stenosis.
Codes
I70.0, I31.1, I51.5, 33415
ASA Crosswalk Lookup
33415=20 base value units=00562
Overall anesthesiology code for the case for the billing anesthesiologist
00562-AA-P3
Clinical viewpoint
The patient has severe medical problems (P3) requiring aortic valve surgery with excision of calcium deposits. Anesthesia (00562) is for procedures on heart, pericardial sac, and great vessels of chest with pump oxygenator, age 1 year or older, for all non-coronary bypass procedures.
Case 43
Anesthesiologist personally provided the general endotracheal anesthesia for the case (PS III). A 55 year old female patient has atherosclerotic heart multi-vessel disease of native coronary artery with unstable angina pectoris. She has had cardiac chest pain for over two years. A coronary angiogram performed one week ago showed 90% stenosis in the left anterior descending artery (LAD), 85% stenosis in the right posterior descending artery, 85% stenosis in the obtuse marginal artery (OM) of the left circumflex, and 85% in the Diagonal artery of the left coronary artery. She undergoes aortocoronary bypass graft utilizing Y-graft and was placed on cardiopulmonary bypass. She undergoes cardiopulmonary bypass utilizing the arterial graft left inferior mesenteric artery (LIMA) graft to the LAD; 3 venous grafts, saphenous vein graft to the right posterior descending artery, saphenous vein graft to the obtuse marginal (OM), and saphenous vein graft to the Diagonal.
Codes
I25.110, 33533+33519
ASA Crosswalk Lookup
33533=18 base value units=00567
33519=not a primary procedure code
Overall anesthesiology code for the case for the billing anesthesiologist
00567-AA-P3
Clinical viewpoint
The cardiac patient has severe (PS III) multi-vessel coronary artery disease and undergoes aortocoronary bypass graft utilizing Y-graft. She was placed on cardiopulmonary bypass requiring a 4-vessel coronary artery bypass graft (CABG), three venous for combined arterial-venous grafting and one arterial (33533+33519). The anesthesia (00567) is for direct coronary artery bypass grafting; with pump oxygenator. 
Case 44
Anesthesiologist personally provided the monitored anesthesia care (MAC) for the case (PS III). A 55 year old male with a history of coronary artery disease presents with chest pains. He undergoes Myocardial perfusion imaging tomographic (SPECT), multiple studies with stress exercise. SPECT scan finds myocardial ischemia.
Codes
I25.10, I51.3, 78452
ASA Crosswalk Lookup
78452=not listed
01922 as listed in CPT book Anesthesia for non-invasive imaging or radiation therapy
Overall anesthesiology code for the case for the billing anesthesiologist
01922-AA-QS-P3
Clinical viewpoint
The patient presented with chest pain and was found to have myocardial ischemia on SPECT Myocardial perfusion tomographic imaging (78452). The CPT code 78452 is not listed in ASA Crosswalk. The corresponding anesthesia code is for anesthesia for non-invasive imaging (01922). The anesthesia is monitored anesthesia care (MAC) (QS).
Case 45
Anesthesiologist personally provided the general endotracheal anesthesia for the case (PS III). A 57 year old female patient has a benign tumor of the vagina with tubo-ovarian abscess not responsive to antibiotics from one week ago. The patient undergoes an open vaginal hysterectomy for a 250 g uterus and a bilateral salpingo-oophorectomy. The surgery had emergency bleeding.
Codes
D28.1, N70.03, 58262
ASA Crosswalk Lookup
58262=6 base value units=00944
Overall anesthesiology code for the case for the billing anesthesiologist
00944-AA-P3,
+99140
Clinical viewpoint
Look up the neoplasm code (D28.1) in the neoplasm table. The anesthesia (00944) is for vaginal procedures (including biopsy of labia, vagina, cervix, or endometrium); vaginal hysterectomy. In this case, there was an Emergency or qualifying circumstance of anesthesia complicated by emergency conditions (+99140), i.e. emergency bleeding which is worth 2 base value units in the units calculation in Relative value guide.


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