Anesthesia Coding Alert

Tip: Surgeon's documentation can also help your coding accuracy.

When coding for anesthesia during coronary artery bypass graft (CABG) procedures, factors such as the patient's age and whether physicians used specialized equipment during surgery can affect your reporting.

You'll be on your way to pain-free CABG coding if you remember three do's -- and one don't -- offered by cardiac anesthesia coder Judy A. Wilson, CPC, CPC-H, CPC-P, CPC-I, CANPC, CMBSI, CMRS, business administrator for Anesthesia Specialists, PTR, in Virginia Beach, in the "Cardiovascular and Thoracic Anesthesia Billing" workshop at the AAPC's Nashville regional conference in September.

Do Examine the Code Choices

CPT® includes three codes for anesthesia during CABG procedures:

• 00562 -- Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, age 1 year or older, for all non-coronary bypass procedures (e.g., valve procedures) or for re-operation for coronary bypass more than 1 month after original operation
• 00566 -- Anesthesia for direct coronary artery bypass grafting; without pump oxygenator
• 00567 -- Anesthesia for direct coronary artery bypass grafting; with pump oxygenator.

The associated base units vary according to the procedure. Code 00562 carries 20 base units, code 00566 carries 25 base units, and code 00567 carries 18 base units.

Do Watch for Pump Documentation

The first question you need to answer when coding anesthesia during CABG is whether the anesthesiologist used a pump oxygenator during the procedure.

Definitions: A case is considered "on pump" when the physician uses a pump oxygenator to stop the patient's heart and lungs during surgery. An "off pump" case occurs when the surgeon operates on the patient's still-beating heart.

"The physician must document 'off pump' before you can report the codes with higher base unit values," Wilson says. "It can be worth approximately $85 more for an average Medicare case, but be sure your anesthesiologist has earned it before you code it."

"The key to reimbursement is documentation," Wilson adds, "just like with any other type of procedure."

Don't Always Add Qualifying Circumstances

Some payers allow coders to report "qualifying circumstances" codes that explain aspects of the patient's situation that complicated the anesthesiologist's work. Three of these codes might apply to cardiovascular cases:

• 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)
• 99116 -- Anesthesia complicated by utilization of total body hypothermia (List separately in addition to code for primary anesthesia procedure)
• 99135 -- Anesthesia complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure).

Don't automatically include these codes with all CABG procedures, Wilson warns. "Hypothermia is often included in the anesthesia code and should not be reported separately in those cases," she says.

Example 1: Codes 00566 and 00567 include the total body hypothermia and controlled hypotension services represented by 99116 and 99135. Although CPT® doesn't include this information, the ASA Relative Value Guide includes parenthetical comments that the descriptors take hypotension and hypothermia into consideration.

Example 2: Code 00562, however, specifies that the patient is age 1 or older. If the patient is under one year of age and you code a heart procedure with 00562, you can include 99100 because of the patient's extreme age. Insurers who recognize qualifying circumstances codes will pay one additional base unit for 99100.

Do Look for Notes That Add Units

Read your anesthesiologist's notes and the operative report carefully, because documentation can sometimes justify extra base units.

For example, if the surgeon sews a graft during an off -pump procedure, the anesthesiologist is due one additional unit due to the increased risk. You can also shift from 18 base units with 00567 to 20 base units with 00562 if the CABG procedure includes another heart procedure such as valve placement or if the patient is having a re-do CABG more than one month after an original CABG surgery.

"You need to look at the operative note along with the anesthesia record to get the full picture," Wilson says. "If something is mentioned in the surgical note, that counts as documentation you can use in your anesthesia coding."