Anesthesia Coding Alert

Things don't always turn out the way the anesthesiologist (or the surgeon) plans and when surgeons are forced to perform surgical procedures they weren't expecting, anesthesia coders need to be able to think on their feet.

When surgical procedures change on the fly, anesthesia coders must answer two questions: First, does the new surgical code merit a new anesthesia code for accurate billing? And second, how important is it to have the absolutely correct CPT procedure code if the corresponding anesthesia code stays the same?

Anesthesia Codes Are More General Than Surgicals

Surgical CPT codes, by nature, are very specific about the procedures they report. A primary procedure code may have multiple subcodes related to it; each code varies slightly from the others in the group so that exact services can be reported. But since the anesthesia used for this group of similar procedures will usually remain the same, the surgical codes often cross to the same anesthesia code.

For example, CPT lists 12 codes related to cataract removal, ranging from 66830 (Removal of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid] with corneo-scleral section, with or without iridectomy [iridocapsu-lotomy, iridocapsulectomy]) to 66986 (Exchange of intraocular lens). Each code describes a particular technique or approach to the surgery, but they all cross to anesthesia code 00142 (Anesthesia for procedures on eye; lens surgery).

"The point is that the CPT surgical codes are much more descriptive of procedures, whereas the anesthesia codes are more general," says Emma LeGrand, CCS, CPC, office manager for the physician group New Jersey Anesthesia Associates PC, in Florham Park, N.J. "That's good, because surgical codes need to be more specific so procedures can be reported as accurately as possible. But since anesthesia administration is often the same for similar procedures, the anesthesia codes are broader and apply to more situations."

Is It Ever OK to Change the Code?

Sometimes the original procedure's code remains in the patient's anesthesia record, even if the services performed are different. What should you do when coding for the case if you notice that the operative notes describe a procedure other than the one originally anticipated?

For example, a patient may be scheduled for a cystourethroscopy (52000, Cystourethroscopy [separate procedure]), but the patient's record reflects a cystourethroscopy with biopsy (52204). Both surgical codes crosswalk to anesthesia code 00910 (Anesthesia for transurethral procedures [including urethrocystoscopy]; not otherwise specified), so the anesthesiologist will be reimbursed correctly either way.

Because a growing number of carriers are more interested in the anesthesia codes than the corresponding surgical codes, some coders tend to let these types of slight inaccuracies slide. But others strive to ensure that the surgical code is correct, even if the differences between codes are minor. Which stance is correct? It can depend on the situation.

If coders notice discrepancies when they audit accounts, they often make a notation that the CPT surgical code was incorrect, even if it crosswalked to a correct anesthesia code. The next step is usually to discuss the original and actual codes with the coder to help ensure accuracy in the future.

"Having minor discrepancies is not uncommon and can be due to a number of reasons, such as the anesthesiologist not giving you complete information," says Barbara Johnson, CPC, MPC, professional coder with Loma Linda University Anesthesiology Medical Group in Loma Linda, Calif. If the code matches the anesthesia record and does not change the resulting anesthesia code, Johnson recommends showing the coder the discrepancy but not changing the code itself.

"Years ago, many carriers wanted the CPT surgical codes and the anesthesia codes to match exactly," Johnson says. "You want your coding to be as accurate as possible, but today many carriers accept either ASA or CPT anesthesia codes.
That means they're not as picky about matching surgical and anesthesia codes."

Still, there are times when little differences in how a procedure is performed can make a big difference in anesthesia reimbursement. One prime example is coronary artery bypass graft surgery, or CABG. Several surgical codes apply to the procedure 33510-33516, 33517-33523 and 33533-33536 and they cross to three different anesthesia codes 00562, 00563 and 00566.

Before you can code the anesthesia portion of the procedure correctly, you must know certain facts about the procedure whether the grafts were venous or arterial and venous, whether the procedure was performed with or without the pump oxygenator, and whether hypothermia was induced. This type of information may not be given by the anesthesiologist, so the coder must rely on procedure documentation or follow-ups with the surgeon's office to ensure correct coding.

"Once the procedure begins, the surgical CPT code can change slightly or extremely," Johnson says. "Many anesthesiologists will not record the updated information, so we're billing based on the planned procedure. We often need more information from our physicians, yet there are ways we can code and bill without losing revenue and still be within the parameters of what was done."