Anesthesia Coding Alert

Positions, approaches, and more can make big differences.

Every anesthesia coder knows that CPT^® anesthesia codes are based on anatomic location and that each code can represent numerous surgical procedures. Because of this, verifying specific details such as procedure location and surgical approach can make all the difference in reporting a code such as 00600 (Anesthesia for procedures on cervical spine and cord; not otherwise specified) with 10 base units versus 00604 (… procedures with patient in the sitting position) with 13 base units.

And, as every experienced anesthesia coder also knows, every base unit you can legitimately report on a claim adds to the bottom line. Read on for advice on how to pinpoint details in your provider’s documentation that can lead to higher base unit tallies and increase reimbursement.

Focus on 3 Questions

Ask yourself these types of questions to ensure you choose the best coding option for any situation:

1. What body area is involved? Then drill down even further: If an extremity, is it upper or lower? On what part of the body is the affected skin? Is it upper or lower abdomen? Getting operative notes or other documentation can usually give you all the details needed to determine the correct anatomic location.

2. What surgical approach was used? Did the surgeon opt for laparoscopic, thoracoscopic, or endoscopic? Do you see documentation of laparotomy, thoracotomy, or another incision?

3. What was the patient’s position during the procedure (prone, supine, beach chair, or other)?

Why it’s important: Any of these details can point you to higher-based codes or allow you to add extra units to the claim to reflect a higher level of work by the anesthesia provider. For example, field avoidance is built into most anesthesia codes for procedures on the facial area (such as 00120, Anesthesia for procedures on external, middle, and inner ear including biopsy; not otherwise specified, with a base value of 5 and 00162, Anesthesia for procedures on nose and accessory sinuses; radical surgery, with a base value of 7)— which is why they are each valued at five units or more. However, sometimes the situation might justify adding additional units to reach the five-unit threshold for field avoidance (provided you have clear documentation supporting the claim).

“If a procedure meets field avoidance criteria, you can charge five base units for it even if it is normally valued at less than five,” says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida.

Justification: The 2019 ASA Relative Value Guide (RVG^®) introduced a new guideline that reads “Whenever access to the airway is limited (eg, field avoidance), the anesthesia work required may be substantially greater compared to the typical patient. This anesthesia care has a minimum base unit value of 5 regardless of any lesser base unit valued assigned to such procedure in the body of the Relative Value Guide. Refer to the text in Modifier 22, page xvi.”

Watch Medical Terminology

Being familiar with common medical terms can also offer more coding clues, Dennis says. For example:

• “Distal incision” describes an incision that is away from the body’s center (such as from the wrist to the fingertip).
•  “Upon entrance the liver was viewed.” Because of the liver’s location, this type of phrase could identify a procedure in either the upper abdomen or lower thoracic cavity. Query the surgeon or review the operative report for more details.
• “An incision was made lateral to the umbilicus and taken in a cephalic direction.” This note means the incision was made on the side and in an upward direction.

Top tip: “It’s important that coders understand they should code where the procedure is performed, not just where the incision is made,” Dennis says. “Keeping that in mind will always help point you in the right anatomic direction and lead you to the most accurate code—and the correct base unit value for accurate reimbursement.”