Anesthesia Coding Alert

Hypothermic circulatory arrest:

Arm Yourself With the Correct Codes

CPT includes several codes for anesthesia during cardiac or CABG procedures, but they don't all apply to hypothermia cases. Your two options are:

Whether you usually report 00562 or 00563 will depend on the physician group and types of cases they handle. "We see more cases using circulatory arrest for cardiac and intracranial procedures," says Julee Shiley, CPC, CCS-P, CMC, an anesthesia coding consultant in Columbia, S.C.

If the anesthesiologist participates in a standard CABG case using routine hypothermia, report 00562, says Barbara M. Johnson, CPC, MPC, president of the consulting firm Real Code Inc., in Moreno Valley, Calif. Code 00563 comes into play when the physician induces circulatory arrest.
 
Pitfall: Cardiac codes 00560 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator) and 00566 (Anesthesia for direct coronary artery bypass grafting without pump oxygenator) don't apply to hypothermia cases.
 
In hypothermia cases, the anesthesiologist uses a pump oxygenator to achieve deliberate hypothermia levels and to rewarm the patient following the procedure. Codes 00560 and 00566 don't apply to these cases because they describe cardiac procedures that do not use the pump oxygenator.

Double-Check Temperatures and Staffing

Shiley says one of her greatest challenges when coding these cases is training the anesthesiologist to indicate that he induced hypothermia. You should also check the anesthesia record to verify that the patient's temperature reached total body hypothermia so you can code accordingly.
 
"The American Society of Anesthesiologists' guidelines say that total body hypothermia is 18-20 degrees Celsius," Johnson says. "It's important to keep the patient's core body temperature under 20 degrees."
 
Tip: Remember that the surgeon can cool down individual arteries while performing a CABG and not induce total body hypothermia, Johnson adds. Don't bill for hypothermia in this case.
 If a case appears to involve hypothermia, Shiley recommends that you double-check records before coding. "It's a good idea to cross-reference the patient's temperature recorded on the anesthesia record in addition to the CRNA or physician indication that he or she utilized hypothermia," she says.
 
Remember: Procedures using induced hypothermia are complicated, so they often involve more than one anesthesia provider. Be sure to append all the appropriate performance modifiers depending on each provider's role:

 

"There probably are not many cases that need two anesthesiologists," Johnson says. "If they are needed, be sure the providers document its medical necessity."
 
Also cross-check the modifiers to ensure that you code correctly for different team members' services. For example, be sure an anesthesiologist reports modifier -QK if a CRNA reports modifier -QX.

Consider Reporting 99116

Because the anesthesiologist lowers the patient's temperature to hypothermic levels during the procedure, some coders also like to report +99116 (Anesthesia complicated by utilization of total body hypothermia [list separately in addition to code for primary anesthesia procedure]). Doing this adds some details to your claim, but that doesn't mean your reimbursement changes.
 
Code 99116 is a "qualifying circumstances" code listed toward the end of CPT's medicine section. Medicare considers hypothermia to be bundled with the CABG and other pump codes with no exemptions, so you can't append modifier -59 (Distinct procedural service) to the procedure and get paid for both codes.
 
Most coders recommend steering clear of reporting 99116 to Medicare or other non-paying carriers so you don't risk accusations of unbundling a Medicare service that's always bundled.
 
"I've always felt that billing for something the carrier won't pay for is just inflating the accounts receivables," Johnson says. That leads to increased write-offs, which is something no practice wants.

Exception: However, Shiley says that all hope for 99116 reimbursement isn't lost just because government carriers do not pay for any qualifying circumstances codes (99100-99140).
 
"Some commercial plans (such as Cigna, Blue Cross/Blue Shield and United Healthcare) reimburse 99116," Shiley says. "Our physicians can receive anywhere from $20 to $342 for reporting 99116."
 
That's why it pays to be familiar with each carrier's policies when coding for hypothermia.