Anesthesia Coding Alert

Extra units for reimbursement might be lurking in places other than the charge ticket.

Anesthesia coders have an advantage over co-workers in other specialties: you have more resources when it's time to comb through charts for all the information you need. Use that access to the anesthesia record, charge ticket, and surgical report to track down every detail that might help your claim.

Unique challenge: "So many practices use a charge ticket in addition to the anesthesia record," points out Cindy Hinton, CPC, CCP, CHCC, owner of Advanced Coding Solutions in Franklin, Tenn. "Many times, discrepancies occur when information is transferred from the anesthesia record to the charge ticket. It's important to compare the charge ticket to the anesthesia record, to make sure all key components are accounted for."

Read on for key pieces of information Hinton and Diane Crosthwaite, CPC, CANPC, coding manager with abeo in Pasadena, Cal., say you should focus on in your provider's anesthesia record.

1. Line Placements

Line placement is one service you can code in addition to the anesthesia service, so don't miss that chance.

Watch for notes regarding Swan-Ganz catheters (93503, Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes), arterial lines (36620-36625, Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; ...), or central venous catheter placement (36555-36571). Your provider should also clearly document the line's purpose, such as additional monitoring or for use in postoperative pain management after the procedure.

2. Diagnosis and Procedure

You must know the procedure being performed in order to select the correct anesthesia code. General information regarding the patient's diagnosis and any past or present health conditions that can affect the procedure might change your coding.

Here's why: Conditions such as hypertension, past coronary or pulmonary problems, or chronic diseases can increase the anesthesiologist's risk or help justify the need for anesthesia. For example, the anesthesiologist might need to take extra precautions during surgery on an obese patient with hypertension. A diagnosis of claustrophobia or Parkinson's can support medical necessity for anesthesia during "standard" procedures like an MRI.

3. Type of Anesthesia

Did the physician or CRNA provide general anesthesia, a regional, or monitored anesthesia care (MAC)? The answer to this question can affect your coding, such as when you need to append modifier G8 (Monitored anesthesia care [MAC] for deep complex, complicated, or markedly invasive surgical procedure) or G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition) to the claim.

4. TEE, Fluoro, BIS Monitoring

You can sometimes separately report other services the anesthesiologist provides during the procedure. Watch for documentation of these, including:

• Transesophageal echocardiography (TEE) probe placement (93313, Echocardiography, transesophageal, real-time with image documentation [2D] [with or without M-mode recording]; placement of transesophageal probe only). Ask your providers to specify "monitoring" or "diagnostic" when they use TEE so you can code appropriately.
• Fluoroscopic guidance for blocks or catheters used to provide postoperative pain management or placement of a central venous or Swan-Ganz catheter. These services are represented by codes such as 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) and +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [List separately in addition to code for primary procedure]).
• BIS monitoring, 95955 (Electroencephalogram [EEG] during nonintracranial surgery ([e.g., carotid surgery]). The ASA bundles BIS monitoring under the "Practice Advisory on Intraoperative Awareness." Some private insurers, however, will pay for BIS monitoring under 95955.

"These services are paid at a flat surgical rate unless your contract with the payer specifies ASA unit reimbursement," Crosthwaite says.

Next month: Four more documentation areas to watch so you'll have a complete coding picture.