Anesthesia Coding Alert

Diagnosis, PQRI, and E-prescribing top experts' lists of watchpoints.

Approximately 600 coders, physicians, and office managers gathered in Orlando, Fla. for the December 2011 Coding and Reimbursement Update Conference. Experts in 13 different specialties shared their insights in a weekend full of workshops, including anesthesia and pain management. As you move into 2011, keep these four areas in mind to strengthen your claims.

Enhance Claims With New Diagnosis Options

The 2011 edition of ICD-9 includes several diagnosis changes that could help anesthesia coders submit more accurate claims. Three welcome additions include:

• 278.03 (Overweight and obesity; obesity hypoventilation syndrome) -- Obesity could be a risk factor for administering anesthesia because the patient might have breathing problems that lead to lower oxygen and higher carbon dioxide levels in the blood. Adding 278.03 to your claim can help justify medical necessity for anesthesia or help justify a higher physical status indicator (P code) for the patient.
• 784.92 (Other symptoms involving head and neck; jaw pain) -- Previously, your only option for reporting jaw pain was 526.9 (Unspecified disease of the jaws). Now 784.92 applies to either mandibular or maxilla pain.
• V85.41-V85.45 (Body Mass Index 40 and over, adult; ...) -- A patient's Body Mass Index (BMI) can be used when you report PQRI measures or to justify higher level P codes. The new diagnoses break BMI into specific ranges instead of grouping everything 40 and above together. For example, V85.41 represents BMI of 40.0 to 44.9; V85.42 represents BMI of 45.0 to 49.9. "Just remember you need to have things specified in the documentation or you have to use the 'unspecified' diagnosis," said Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

Look Closer at PQRI Reporting

PQRI has included anesthesia measures for a while, but 2011 is the first time they've appeared in CPT, Judith Blaszczyk, RN, CPC, ACS-PM, pointed out during her workshop on "Take Steps Now to Prepare for 2011 Anesthesia Changes."

Three PQRI measures apply to anesthesia providers: timing of prophylactic antibiotic (measure 30); maximal sterile barrier technique (measure 76); and active warming/temperature (measure 193). You have three reporting options:

• Measure 76 alone
• Measures 76 and 193
• Measures 30 and 76.

Whichever option you choose, "You must report on 80% of qualifying cases," Blaszczyk said. Successful reporting means a 2 percent bonus payment for your physician.

Caution: "Not every anesthesia code falls under a PQRI measure," Blaszczyk added. Codes for cataract surgery, for example, don't qualify for PQRI reporting, so check the PQRI website for the latest updates. If you report a case to PQRI that includes both qualifying and non-qualifying codes, Blaszczyk recommends submitting everything on separate lines. "It's okay to still include a code that doesn't qualify for the measure. They'll just ignore it."

Practice E-Prescribing

E-prescribing is here to stay --" and is about to be more strictly enforced.

Heads up: Physicians need to e-prescribe at least 10 medications for patients during the first 6 months of 2011, or they'll be added to the list for a 1% penalty hit in 2012.

"The prescriptions can be for one patient ten different times, or can be spread out among different patients," said Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, during her presentation on "Take Steps Now to Prepare for 2011 Pain Management Changes." "For pain management practices, the prescriptions can be for any type of pain meds," she adds.

Face ICD-10 With Confidence

No matter how many years you've been coding, you probably heard that "ICD-10 is on the way" when you entered the profession. Now that it's looming as a reality, take a deep breath and know that you'll be OK. "We learned to use ICD-9, and we'll learn to use ICD-10," Dennis said during her session "Diagnosis Coding for Anesthesia." "We can do this! We are not afraid."

Preparation: Start preparing for ICD-10 codes with digits that specify certain things. The first digit will recognize the disease chapter; the second digit will describe the location; the third digit will explain details of the condition.

Bonus: Beginning in 2011, each issue of Anesthesia Coding Alert will include information about how you'll code some of your most common diagnoses when ICD-10 goes into effect. Save these tidbits for future reference, and you'll have a head start on how to find the diagnoses you'll need.