Anesthesia Coding Alert

Tip: Catch extra procedures before they slip through the cracks

If your physicians find themselves spread throughout the hospital campus " as most anesthesia providers are -- don't let those claims slip through the cracks. Be sure you're capturing all of their services and reporting modifier 23 (Unusual anesthesia) when appropriate.

Key Words Help You Catch Claims   

You can append modifier 23 to any non-OR procedure that your providers document sufficiently. Train your practitioners to keep these details in mind as they document cases so you can code more accurately:
 
• General anesthesia: The physician or CRNA must administer general anesthesia, not monitored anesthesia care (MAC), for the procedure. "By definition, the 23 modifier indicates 'a procedure which usually requires no anesthesia or local anesthesia, but because of unusual circumstances must be done under general anesthesia,' " says Kelly Dennis, CPC, owner of Perfect Office Solutions in Leesburg, Fla.
 
• Medical necessity: Many procedures that qualify for modifier 23 don't normally require anesthesia. If the other physician requests anesthesia for the procedure, be sure your provider documents why the patient needed anesthesia. Underlying conditions that help justify anesthesia range from Parkinson's disease (332.x) and mental retardation (317-319) to claustrophobia (300.29, Other isolated or specific phobias) and cerebral palsy (343.x, Infantile cerebral palsy; or 437.8, Other and ill-defined cerebrovascular disease; other).
 
The patient's age can also help justify anesthesia, such as when a small child undergoes a lumbar puncture.

 • Procedure specifics: "The extent of the service provided could justify the need for general anesthesia and lead to using modifier 23," adds Emma LeGrand, CPC, CCS, coding supervisor of New Jersey Anesthesiologists in Florham Park. Example: Some debridements only require a local anesthetic, so the physician or nurse performs the procedure at the patient's bedside. If the debridement is more extensive, however, the physician might choose to perform it in the OR, which means an anesthesia provider is present.

Radiology, PM Claims Crop Up More Often    

Radiologists perform an ever-growing range of procedures, which means they need anesthesia services more often. Keep your eyes open for anesthesia during procedures such as these:
 
• Dialysis shunt placement (36145, Introduction of needle or intracatheter; arteriovenous shunt created for dialysis [cannula, fistula, or graft]), which crosses to 01916 (Anesthesia for diagnostic arteriography/
venography)
 
• MRI procedures, which cross to 01922 (Anesthesia for non-invasive imaging or radiation therapy)

 • Angioplasty procedures (35471, 35473, 35474 and 35475, select codes for Transluminal balloon angioplasty, percutaneous), which cross to 01924 (Anesthesia for therapeutic interventional radiologic procedures involving the arterial system; not otherwise specified)
 
• TIPS (transvenous intrahepatic portosystemic shunt) insertion (37182, Insertion of TIPS [included venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract formation/dilatation, stent placement and all associated imaging guidance and documentation]), which crosses to 01931 (Anesthesia for therapeutic interventional radiologic procedures involving the venous/
lymphatic system [not to include access to the central circulation]; intrahepatic or portal circulation [e.g., transcutaneous porto-caval shunt (TIPS)]).

Some pain management specialists or interventional radiologists also request anesthesia during their procedures.
 
Lorraine Gledhill, CPC, an anesthesia coder with Lahey Clinic in Burlington, Mass., says her physicians sometimes provide anesthesia for kyphoplasty (22523-22525, Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, one vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty] ...) or vertebroplasty (22520-22522, Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection ...).

 If your physician provides anesthesia during the procedure instead of administering the injection, you can report 01905 (Anesthesia for myelography, diskography, vertebroplasty).
 
Documentation check: Surgeons should clearly document the need for an anesthesia provider's involvement in the case, especially when you'll be reporting modifier 23. Their documentation should coincide with your anesthesia record just as in standard OR cases.
 
The more closely the surgical and anesthesia records match, the better chance you have of receiving appropriate reimbursement for the unusual anesthesia service provided.