Anesthesia Coding Alert

Don't miss how to count time for +01953.

Coding for anesthesia during burn excision or debridement differs from other situationsbecause you don't simply choose a code based on the anatomic location. Instead, you focus on the extent of burn injury, which means you might need to brush up on some math skills.

Know Your Code Choices

CPT Codes provides 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 percent total body surface area
• 01952 ��" . . . between 4 percent and 9 percent of total body surface area
• +01953 ��" . . . each additional 9 percent total body surface area or part thereof (List separately in addition to code for primary procedure).

Important: Report +01953 with 01952, according to CPT instructions. "You shouldn't skip 01952 to get to the add-on code," says Debbie Farmer CPC ACS-AN, with Auditing for Compliance and Education, Inc., in Leawood, Kan. "Only reporting +01953 can cause the payer to deny the claim or lead to underpayment."

Calculate TBSA -- Here's How

The attending physician should document the TBSA of the burn victim, often in collaboration with your anesthesiologist. The physicians need to agree on the amount of affected area so their claims will be consistent. For example, the anesthesiologist shouldn't bill for an 18 percent body burn when the surgeon claims a 32 percent body burn. CPT and ICD-9 both include information on "The Rule of Nines," or the system physicians use to determine the extent of burn wounds. CPT's illustration appears with burn treatment codes 16000-16030. ICD-9 includes instructions, diagrams, and specific diagnoses under the burn code families 940.x-949.x.

If the surgeon or burn specialist only notes the area being debrided, Farmer says your anesthesiologist or coding staff can use the TBSA graphic in CPT to determine the TBSA. "Review CPT guidelines under the burn codes against the anesthesia codes to be sure the appropriate codes are reported based on the percentage debrided," she says.

Caution: Don't guess or simply assign the lowest level of burn code if the physician doesn't document the TBSA, warns Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, president of Perfect Office Solutions, in Leesburg, Fla. "Request additional information and communicate with the anesthesia provider to ensure he or she provides what you need," Dennis says.

Steer Clear of P Modifiers for +01953

When reporting an anesthesia service, you sometimes need to include a physical status modifier describing the patient's state at the time of the procedure. "Physical status modifier reporting is dependent on payer guidelines," Farmer says. "Some require reporting all modifiers while others only have you report the payable modifiers (P3 to P5)."

If your payer requires physical status modifiers, your choices include:

• P1 -- Normal healthy patient
• P2 -- Patient with mild systemic disease
• P3 -- Patient with severe systemic disease
• P4 -- Patient with severe systemic disease that is a constant threat to life
• P5 -- Moribund patient who is not expected to survive without the operation
• P6 -- Declared brain-dead patient whose organs are being removed for donor purposes.

Most of your anesthesiologist's services require a simple P1 or P2 modifier. To report P3 or higher, you need clear documentation in the medical record to support it. If your anesthesiologist classifies a patient as P3 or above, many payers will want more information to support the claim, including a secondary diagnosis.

Watch out: You cannot use a physical status modifier with add-on codes, including +01953, according to the American Academy of Professional Coders.

Use RVG as Your Burn Backup

The ASA's Relative Value Guide (RVG) provides a base value for every anesthesia code. After using your CPT manual to select the best code, look the code up in the Crosswalk to select the correct anesthesia code. If the Crosswalk lists alternate codes, refer to the RVG to select the appropriate code.

Remember: According to RVG, the base value provided includes the value "of all usual anesthesia services except the time actually spent in anesthesia care, and any modifiers." Count Time Based on Code Anesthesia start time occurs 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.

Time tip: When you code for a case involving 01952 and +01953, remember to correctly allocate the time units. According to the Relative Value Guide, "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 gives his report ��" in other words, when he transfers care of the patient.