Anesthesia Coding Alert

Test yourself to see how well you interpret these abbreviations.

If the charts you code from sometimes look like alphabet soup because of specialized acronyms or abbreviations your providers use, it's time to brush up on some common terms to help improve your coding.

Here's why: When the physician documents a chart, he doesn't always have time to spell out phrases such as "past history" (PH) and "present illness" (PI), but knowing which is which can make a tremendous difference in the accuracy of your charts. If you code a chart assuming that the patient currently suffers from every condition listed as "PH," you'll be coding the wrong diagnoses for the current illness.

Does 'TKA' Mean Visualizing or Replacing?

The physician documents "TKA" in the patient' chart, which could stand for "total knee arthroplasty" or "total knee arthroscopy." During arthroplasty, the surgeon repairs or replaces a joint. During arthroscopy, by contrast, the surgeon uses minimally invasive techniques to look inside the patient's joint to better diagnose problems and possibly provide some treatment.

Possibility 1: The correct CPT® surgical code for total knee arthroplasty is 27447 (Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee arthroplasty]). Code 27447 crosses to anesthesia code 01402 (Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty), which carries a base value of 7 units.

Possibility 2: CPT® includes a range of codes for total knee arthroscopy, depending on the specific procedure. Each choice crosses to anesthesia code 01400 (Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified), which is valued at 4 base units.

Shifting from 4 base units with 01400 for arthroscopy to 7 base units with 01402 for arthroplasty is a substantial change. Misinterpreting "TKA" in your anesthesia provider's notes certainly will affect your bottom line, so check other chart notations and query your provider to verify the surgeon's work.

Does 'I&D' Point to Clean Up or Incision?

Suppose the doctor documents "I and D" on the chart. "I've seen this documented for both 'irrigation and debridement' and 'incision and drainage,'" says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. "This is another example of two different types of procedures with two different surgical codes, so be sure you know what your provider means."

Possibility 1: You code irrigation and debridement with the appropriate selection from a large range of codes, depending on which level of skin the surgeon reaches. Several of the options  for surgical codes cross to either 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) with 5 base units or 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) with 3 base unit value. However, other options send coders to more specific anatomical codes, so make certain you understand which code selection is appropriate.

Possibility 2: You code incision and drainage, however, with a choice from 10060-10180. The code descriptors vary according to what the surgeon incised and the level of complexity. Each code crosses to anesthesia codes 00300 or 00400, just as the irrigation and debridement procedures. Pay attention to details and assign the correct CPT® procedure code even though your anesthesia reporting won't change. "An incorrectly assigned diagnosis or procedure may affect the patient's medical history," Dennis points out.