Anesthesia Coding Alert

Underlying conditions can help justify anesthesia use

Whether you code for anesthesiologists at a large or small hospital, chances are you're seeing more charts for services performed outside the operating room. Increase your practice's reimbursement for these "outside-the-norm" services by encouraging underlying diagnosis documentation and using modifier -23 (Unusual anesthesia) when appropriate. Fight for Your Rights in Radiology Departments Radiologists perform an ever-expanding list of complex procedures, creating an increased need for anesthesiologists in radiology departments. This is especially true when interventional radiologists perform cardiac catheterizations and other complicated procedures such as transjugular intrahepatic portosystemic shunt (TIPS) placement or intracranial catheter occlusion or embolization.

Anesthesiologists also assist with AAA (abdominal aortic aneurysm) endoscopic repair and some stent placements, says Barbara Johnson, CPC, MPC, in Loma Linda, Calif.

Your group may also provide anesthesia for less invasive radiology procedures because of special circumstances such as the patient's age or physical status. This is especially true for children or handicapped individuals who have low pain thresholds or who have difficulty remaining still during a procedure, such as an MRI or a CT scan.

"I'm seeing that cases are being performed in the imaging/radiology departments in larger numbers for patients who have difficulty being able to lie still, especially smaller children," says Susan West, RHIT, an anesthesia coding consultant with Auditing for Compliance and Education Inc. in Leawood, Kan. When reporting anesthesia during radiology-related procedures, you'll often rely on codes such as 01920 (Anesthesia for cardiac catheterization including coronary angiography and ventriculography [not to include Swan-Ganz catheter]), 01922 (Anesthesia for non-invasive imaging or radiation therapy) and 01926 (Anesthesia for therapeutic interventional radiologic procedures involving the arterial system; intracranial, intracardiac or aortic). Payment for Diagnostic Tests Can Be Trouble You shouldn't have trouble collecting anesthesia reimbursement for most interventional radiology procedures, but collecting for diagnostic tests such as electrophysiological studies (EPS), MRI or endoscopies can be a different story. You may have to fight for your reimbursement if carriers question the anesthesia's medical necessity during these procedures.

Johnson recommends two steps to help increase your reimbursement odds. "First, remember modifier -23," she says. "Add this to all cases that would not normally be performed under anesthesia and include any documentation supporting anesthesia's use. If your reason for needing anesthesia is based on a medical diagnosis, also include the appropriate ICD-9 code with codes for the service itself."

Three common medical diagnoses that often support anesthesia use in unusual circumstances are claustrophobia (300.29, Neurotic disorders; phobic disorders; other isolated or simple phobias), cerebral palsy (343.x, Infantile cerebral palsy; or 437.8, Other and ill-defined cerebrovascular disease; other) and Parkinson's disease (332.0, Parkinson's disease; paralysis agitans; or 332.1, Secondary Parkinsonism).

Surgeons should clearly document the need for an anesthesia provider's involvement in these [...]