Anesthesia Coding Alert

Audits whether conducted internally or by an outside consultant always cause stress and headaches, but many coders say the secret to making the process as painless as possible is paying attention to a few key areas every day. Report the Most Correct Diagnosis When a postoperative diagnosis is more descriptive of or relevant to a procedure, coders should use it instead of the preoperative diagnosis, says Kelly Dennis, CPC, EFPM, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla. This often happens when the surgeon realizes that something different should be done once the patient is in the operating room, and changes plans accordingly.

For example, a patient could go into surgery with a preprocedure diagnosis of pelvic mass (789.30, Abdominal or pelvic swelling, mass, or lump; unspecified site), but the surgeon sees that it is an ovarian cyst once the procedure begins (620.2, Noninflammatory disorders of ovary, fallopian tube, and broad ligament; other and unspecified ovarian cyst). You should report the more accurate postprocedure diagnosis because of its accuracy, even if it doesn't change the course of anesthesia or the anesthesiologist's reimbursement. More than one supporting diagnosis for a particular case may be required, depending on the situation and the carrier. (Many carriers require three or four documented diagnoses for patients with a physical status of P3 or higher.) Although having multiple diagnosis codes is not always as important in anesthesia billing as in other specialties, Emma LeGrand, CCS, CPC, office manager of the physician group New Jersey Anesthesia Associates in Florham, N.J., says additional diagnoses may help justify an anesthesiologist's presence when you bill MAC (monitored anesthesia care) for endoscopic or noninvasive procedures that do not usually warrant anesthesia. For example, most patients do not require anesthesia before an MRI for a bone marrow study (76400, Magnetic resonance [e.g., proton] imaging, bone marrow blood supply). But if the patient is a young child or has complicating factors such as claustrophobia (300.29, Phobic disorders; other isolated or simple phobias) or Parkinson's disease (332.0, Parkinson's disease; paralysis agitans), anesthesia may be used to help make the test go more smoothly. If a secondary diagnosis is given, Dennis says, it's not a bad idea to include it, though she adds, "I would not consider it a huge problem in an internal audit if the coder only listed the diagnosis related to the problem." Double-Check Procedure Times Because time units are such an important part of the anesthesia billing equation, check patient records to ensure that the reported times make sense.

"I visually look at the times [in the patient's record] to make certain that the anesthesia start and stop times are reasonably close to the surgical start and stop times," Dennis [...]