Anesthesia Coding Alert

For burn codes such as +01953, a little TBSA knowledge helps you code.

CPT provides three anesthesia codes for burn excision/debridement that are quite distinct from the anesthesia codes you're used to seeing on a day-to-day basis. Take the time to refresh your knowledge on these burn codes to ensure your setting is up to date.

Take a Peek at Burn Anesthesia

The three anesthesia codes for burn excision/debridement that CPT offers are:
 • 01951 -- Anesthesia for second- and third-degree burn excision or debridement   with or without skin grafting, any site, for total body surface area (TBSA) treated   during anesthesia and surgery; less than 4 percent total body surface area
 • 01952 -- . . . between 4 percent and 9 percent of total body surface area
 • +01953 -- . . . each additional 9 percent total body surface area or part thereof   (List separately in addition to code for primary procedure).

Important note: You should use +01953 with 01952, according to CPT. You can't skip 01952 to get to the add-on code.

Check Up on TBSA -- Here's How

 The attending physician should document the TBSA of the burn victim, often in collaboration with your anesthesiologist. "The surgical and anesthesia record should support each other," says Scott Groudine, MD, professor of anesthesiology for Albany Medical Center in Albany, N.Y. Usually, he adds, the surgeon will determine how large the burn is, but if your anesthesiologist disagrees, "we will come to an agreement because we can't have me billing for an 18 percent body burn and the surgeon claiming a 32 percent body burn."

Generally, TBSA percentage determination is made using "The Rule of Nines." To help determine the extent of burn wounds, doctors have divided the body into 12 sections, front and rear, roughly representing 9 percent of the TBSA each. Exceptions are the genitals, which represent 1 percent, and the arms, which represent 4.5 percent on the anterior, and 4.5 percent on the posterior (whereas each leg is 9 percent on the anterior and 9 percent on the posterior). Knowing these "rules" may help you decipher reports when coding for your anesthesiologist.

Watch for children: For infants and young children, the Rule of Nines is slightly different to allow for the larger surface of the child's head. Children's TBSA is 14 percent per leg, 18 percent for the torso, 18 percent for the back, 9 percent per arm, and 18 percent for the head.

ICD-9 has some information on this "rule," under code 941 (Burn of face, head, and neck). It discusses degree of burns and includes an illustration for the Rule of Nines. Code 941 also provides fifth-digit subclassifications for burn wounds to the head.

Use CPT: In the event the surgeon or burn specialist only notes the area being debrided, your anesthesiologist or coding staff can use the TBSA graphic in CPT to determine the TBSA, says Debbie Farmer CPC ACS-AN, with Auditing for Compliance and Education, Inc., in Leawood, Kan.

Farmer gives common sense advice when it comes to coding these special circumstances. "Review CPT guidelines under the burn codes against the anesthesia codes to be sure the appropriate codes are reported based on the percentage debrided," she says.

Avoid Physical Status Modifiers for +01953

 When reporting an anesthesia service, you  must include a physical status modifier, also known as an ASA (which in this case is shorthand for the American Society of Anesthesiologists Physical Status Modifiers). The ASA modifiers include:
 • P1 -- Normal healthy patient
 • P2 -- Patient with mild systemic disease
 • P3 -- Patient with severe systemic disease
 • P4 -- Patient with severe systemic disease that is a  constant threat to life
 • P5 -- Moribund patient who is not expected to    survive without the operation
 • P6 -- Declared brain-dead patient whose organs   are being removed for donor purposes.

Most of your anesthesiologist's services require a simple P1, P2, or P3 code. To use P4 or higher, you need clear documentation in the medical record to support it. If your anesthesiologist classifies a patient as P3 or above, many payers will want more information to support it. If your anesthesiologist classifies a patient as P3 or above, many payers will want more information to support the claim.

Status mods for burns are trickier: The morbidity from burns is dependent on age, size, depth, and comorbidities," Groudine says. "The P status is dependent on ASA status, and with burns this is no different. An ASA 3 has a condition which is a threat to life, an ASA 4 is a constant threat to life, etc. A 40 percent 2-3 degree body burn to a young, healthy person would make them an ASA 3. If the person were 85 years old this would be a 4 or 5 depending on other conditions," such as smoke inhalation. Be sure your anesthesiologist documents the ASA status so you can choose the proper modifier.

Watch out: You cannot use a physical status modifier with add-on codes, including +01953, according to the American Academy of Professional Coders.

Turn to RVG for Burns

The ASA's Relative Value Guide provides a base value for every anesthesia code. After using your Crosswalk and the CPT manual to select the best code, look the code up in the RVG for possible additional coding instructions and to determine the base value for billing.

Remember: According to RVG, the base value provided includes the value "of all usual anesthesia services except the time actually spent in anesthesia care, and any modifiers."

If a surgeon performs more than one procedure during a single anesthetic administration, and the additional procedure is burn code +01953, report both the primary service code and +01953. You should also report the base value units for each code.

Coding Time Varies with Burn Codes

Anesthesia start time occurs when the anesthesiologist assumes care of the patient and is continuously present. It ends when the care is transferred to another provider.

Time tip: When it comes to coding time, "with burns all time is recorded with the primary code 01952," Groudine says. "The add-on code +01953 is used for each 9 percent over the first 9 percent, and has no time units associated with it."

The recovery room chart should note the time your anesthesiologist releases the patient for post-op care. That time is when anesthesia care is actually finished. If the patient goes to a unit, such as intensive care, the billable anesthesia time continues until the patient is settled and your anesthesiologist gives his report -- in other words, when he transfers care of the patient.