Anesthesia Coding Alert

Anatomic site is the key to your final choices.

Coding for burn care can get tricky from an anesthesia perspective, because you don’t simply crosswalk from a surgical code and add time units. Instead, you must get more specific details about the case than for usual procedures so you can calculate everything on the claim correctly. Read on to ensure you know the key factors to ensure clean claims every time.

Focus on These Codes

As an anesthesia coder, you’re accustomed to focusing on the anatomic site when filing claims. For burns, however, that’s not how you choose the most appropriate code. Instead, you focus on the extent of burn injury across the entire body (or total body surface area, TBSA), which involves calculating information from all affected body areas.

CPT^® includes three anesthesia codes for burn excision/debridement that differ from the anesthesia codes you’re used to seeing on a day-to-day basis:

• 01951 (Anesthesia 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)
• 01952 (… between 4% and 9% of total body surface area)
• +01953 (… each additional 9% total body surface area or part thereof (List separately in addition to code for primary procedure)).

Pay attention: Because +01953 is an add-on code, payers will only reimburse when you report it with the associated primary code: 01952. Because of its add-on status, code +01953 is worth one additional base unit, but you do not report time for it.

Tally the Affected Areas

As you can see by the descriptors, codes 01951 through +01953 are based on the amount of body surface area affected by the burns. That means you need to ascertain totals from specific areas from the provider’s record.

Tip: The surgeon is the best judge of TBSA, but the areas should be clearly documented in both the surgical and anesthesia records so their claims will be consistent.

Begin your calculations of the percentage of involved skin by following the “Rule of Nines,” which you’ll find in both the Professional Editions of  CPT^® and ICD-10-CM under the Lund-Browder Diagram in the Surgery/Integumentary System and Category T31 respectively, says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida.

What it is: The Rule of Nines divides the body into certain areas to help you code burns by percentages (The CPT^® code book includes an illustration explaining the rule with burn treatment codes 16000-16030). The calculations for children are a bit different, but the rule for calculating burns on adults is:

• Head and neck, the right arm, and the left arm each equal 9 percent
• Back trunk, front trunk, left leg, and right leg each equal 18 percent (the front and back trunk are divided into upper and lower segments, and each leg is divided into back and front segments, each equaling 9 percent)
• Genitalia is equal to 1 percent.

Select the appropriate treatment code(s) based on the total percentage. The catch is that means you must also know how to convert any documented areas into percentages.

Example: A patient has third-degree burns to 65 percent of his total body area. The operative report states that the surgeon debrided 1400 square cm of the chest and shoulders but gives no other details. Although 65 percent of the patient’s body is burned, the surgeon is currently treating the chest and shoulders. The treated area represents upper chest (approximately 9 percent) and shoulders (approximately 3 percent each), for an approximate total of 15 percent. The applicable anesthesia codes are based on the TBSA treated—for this case, 01952 and +01953. Submit 01952 once for the first 9 percent, then +01953 x 1 for the remaining 6 percent.

Pay attention: The code descriptor for +01953 reads “or part thereof.” Reporting one unit of 01952 and 1 units of +01953 adds up to 15 percent, which covers the treated area..

Potential bonus: Some cases might justify including a qualifying circumstances (QC) code on the claim. For example, a 10-month-old infant has emergency surgery for third degree burns covering less than 4 percent of the TBSA. Begin your claim with 01951. Then add +99100 (Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)) to the claim since 01951 does not take age into consideration. You could also include +99140 (Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure)) because of the emergency conditions.

Watch Your Times

According to the American Society of Anesthesiologists (ASA) Relative Value Guide (RVG), the base value provided for anesthesia codes includes the value “of all usual anesthesia services except the time actually spent in anesthesia care, and any modifiers.”

Anesthesia start time is marked when the anesthesiologist begins to prepare the patient for anesthesia care in the operating room or equivalent area. Your provider must show continuous presence with the patient. Anesthesia time ends when the anesthesia provider transfers the patient’s care to another healthcare professional.

When you code for a case involving 01952 and +01953, remember to correctly allocate the time units. According to the RVG, “Time for additional TBSAs to be included in that reported for 01952.”

“That indicates that all time is reported on the primary procedure,” Dennis explains. “Unless policy requires otherwise, report time with a ‘1’ for the add-on code.”

The anesthesia record should note the time your anesthesiologist releases the patient for post-op care. That time—when the patient is safely placed in PACU or an equivalent area—determines your anesthesia end time. If the patient goes to a unit, such as intensive care, the billable anesthesia time continues until the patient is settled and your anesthesiologist reports that he has transferred care of the patient.

More to come: Assigning a diagnosis for patients who are treated for burns has just as many considerations as coding for the anesthesia care. In next month’s issue of Anesthesia Coding Alert our experts will delve into diagnosis criteria.