Anesthesia Coding Alert

Although many patients undergo diagnostic procedures without anesthesia, circumstances occasionally merit anesthetizing the patient. One such example is endovascular coiling for an intracranial aneurysm, a procedure performed by a radiologist.

Before explaining the coding options, understanding the procedure is important. The patient undergoes endotracheal anesthesia during what can be described as a multiple, multiple arteriogram, says Jeff Pearce, MD, of Northwest Anesthesia in Oklahoma City. The catheter carrying the coil, a spring-like device, is inserted at the femoral artery in the groin and advances through the aorta, the carotid artery and on to the brain in order to identify the exact location of the aneurysm, malformation or defect. The coil is placed to lessen the severity of bleeding during follow-up surgery to treat the problem. An arterial line is placed to monitor blood pressure and maintain blood flow with no variance during the procedure.

Barbara Johnson, CPC, MPC, National Advisory Board member for American Academy of Professional Coders (AAPC) and anesthesia coder for Loma Linda University Anesthesiology Medical Group in California, says the question of coding is difficult to answer. Its a case where you could get a different answer from everyone you ask, she says. She gives the following advantages and pitfalls to using the various options.

Code CPT 01926 (anesthesia for interventional radiologic procedures; intracranial). This code is in the American Society of Anesthesiologists (ASA) Relative Value Guide but is not in CPT Codes. Because of this, Medicare and other carriers will not accept it. Some commercial carriers will accept this code, but Johnson feels fairly certain that these carriers are in the minority. She recommends that you file with another applicable code instead of this one unless you know the carrier will accept it.

Code 01922 (anesthesia for non-invasive imaging or radiation therapy). The endovascular coiling described is an intracranial procedure and a vascular procedure. CPT refers to CPT 75894 (transcatheter therapy, embolization, any method, radiological supervision and interpretation) for radiological supervision and interpretation, which cross-references with anesthesia code 01922. Medicare does accept this code.

Code 61624 (transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method; central nervous system [intracranial, spinal cord]). This code fits from a surgical perspective, which some carriers may accept. But Medicare requires anesthesia providers to use the CPT anesthesia codes, so they will not accept it from an anesthesiologist. If you try to match this code with the appropriate ASA-sanctioned code, the ASA crosswalk matches it with ASA code 01926, which (as stated above) Medicare does not accept because it is not in CPT.

Code 00216 (anesthesia for intracranial procedures; vascular procedures). Medicare and some commercial carriers will accept this code for the procedure.

This is an intracranial procedure and a vascular procedure, but Johnsons preference is to use anesthesia code 01922 instead of a surgical code or 00216 because the procedure is performed by a radiologist and takes place in the radiology department. After all, no matter what procedure the radiologist is doing, in most cases the anesthesia professional is only anesthetizing the patient. The only time the anesthesiologist should use one of the surgical codes in this situation is if he or she actually performs the procedure personally in addition to providing anesthesia.

Not all hospitals perform the procedure, so Cecelia McWhorter, BA, CPC, a coder with the physician billing agency Comp One Services Ltd., in Oklahoma City, says it may be difficult for anesthesia coders to find someone who can help them determine the best code to use. She states that the procedure is becoming more common, and anesthesia providers should know how to code for it. Were seeing the procedure more and more, and its always performed under anesthesia, she says. Its important to work with your carriers to determine which code or codes they will accept for it so you can get the most appropriate reimbursement.