Anesthesia Coding Alert

Question: Can you give me some assistance with the following procedure? The patient had an umbilical hernia, no other description. I got the operative report to determine whether it was an upper or lower abdomen procedure. It was upper, and in the report it states it was incarcerated. For anesthesia, do I report 00752 or 00790? The surgery time was over two hours and the anesthesia time was 157 minutes. I was told that if the surgery is over two hours, I could add a 22 modifier (Increased procedural services) for additional work. 

Rhode Island Subscriber

Answer: Based on an upper abdominal incarcerated hernia, the correct anesthesia code is 00790 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified). According to the American Society of Anesthesiologists (ASA): “For incarcerated or strangulated hernias, an intraperitoneal approach is likely to be necessary to ensure that there is no residual bowel ischemia or infarction. Upper abdominal intraperitoneal hernia repairs would use anesthesia CPT^® code 00752 [Anesthesia for hernia repairs in upper abdomen; lumbar and ventral (incisional) hernias and/or wound dehiscence] if the hernia is reducible and 00790 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified) if the hernia is incarcerated or strangulated.” Adding a 22 modifier for anesthesia cases over two hours is not reasonable, since anesthesia services are paid by time. The ASA offers a helpful tool that can guide you to the best anesthesia code based on the documentation provided.

Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPMA, CPC, CPC-I,
Perfect Office Solutions, Contributing Writer