Anesthesia Coding Alert

Procedure details determine if you can report them separately Remembering a little-used modifier could be your key to getting paid for wake-up tests, but not all experts agree.

The scenario: The anesthesiologist induces a patient before halo application. After the procedure, he turns the patient prone and performs a wake-up test to ensure the patient isn't paralyzed. Satisfied with the results, he administers general anesthesia to put the patient back to sleep so the surgeon can complete the procedure.
The coding question: Can you report the wake-up test in addition to the anesthesia?

This question is difficult to answer because some details are missing (it was posted on our listserv this way). But adding hypothetical details helps you evaluate the best way to handle the case. Verify the Type of Procedure Your first step in deciding how to handle the situation is to verify the type of surgery performed.

Administering a wake-up test is common practice during spinal surgeries, according to Tonia Raley, CPC, claims processing manager for Medical Information Systems in Phoenix. If the procedure in question is spinal surgery, the extra service of a wake-up test is already included in the increased base values for anesthesia.

Example: Anesthesiologists often perform a wake-up test during spinal instrumentation procedures (such as 22840, Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation]).

Code 22840 crosses to anesthesia code 00670 (Anesthesia for extensive spine and spinal cord procedures [e.g., spinal instrumentation or vascular procedures]). Anesthesia codes for spinal procedures have high base units to reflect the cases- level of difficulty (such as 13 base units for 00670). If the anesthesiologist administers a wake-up test during spinal procedures, the anesthesia code units already compensate for the service.

Although you won't charge extra for the wake-up test in these situations, you-ll still consider it when completing your claim.
 
-You bill the total anesthesia time in addition to the procedure's base units, not only the -asleep- time,- says Julee Shiley, CPC, CCS-P, CMC, a South Carolina coding consultant. -Even if you don't charge separately for the wake-up test, you-ll have extra reimbursement associated with additional time unit(s) due to more extensive service.-

Shiley and Raley say a wake-up test generally takes 30 minutes or less. That might not seem like much time, but every unit counts when you-re filing claims.

Halo note: You must also consider the halo application mentioned above. Although halo applications often go hand-in-hand with cervical spinal procedures, the surgeon could apply a halo for facial procedures such as maxillofacial reconstruction (21100, Application of halo type appliance for maxillofacial fixation, includes removal [separate procedure]).

How you handle reporting the [...]