Anesthesia Coding Alert

It is not uncommon for anesthesia providers to be involved with procedures that do not have anesthesia-specific codes in CPT. Three examples are arthroscopic, laparoscopic and wrist ligament repair procedures. Which existing codes can be used to reflect most accurately the procedure so reimbursement can be appropriate?

Arthroscopic and Laparoscopic Dilemmas

For carriers that will accept surgical codes from anesthesiologists, codes 23410-23420 are for various rotator cuff repairs, but none are for arthroscopic repair. Code 29819 (arthroscopy, shoulder, surgical; with removal of loose body or foreign body) is for arthroscopy of the shoulder with the removal of a loose or foreign body.

However, if the procedure is being filed with an anesthesia code, the anesthesiologist can report his or her services with 01622 (anesthesia for arthroscopic procedures of shoulder joint) points out Barbara Johnson, CPC, MPC, an anesthesia coding professional with Loma Linda University Anesthesiology Medical Group in Loma Linda, Calif.

Laparoscopic procedures, such as hernia repair, should be submitted with the same code as a standard hernia repair (although many coders believe the laparoscopic technique should have a distinct code of its own), says Cheryl Pascale, CMA, CCS, a coder with the physician group Hackensack Anesthesiology Associates in Hackensack, N.J.

Use Most Appropriate ICD-9 codes

A lack of ICD-9 codes to properly explain the diagnosis leading to the procedure is more of a problem to me than coding it, Johnson adds. She cites ligament repair on the back of the wrist as an example.

The surgical CPT code 25320 (capsulorrhaphy or reconstruction, wrist, any method [e.g., capsulodesis, ligament repair, tendon transfer or graft] [includes synovectomy, capsulotomy and open reduction] for carpal instability) is for any method of ligament repair on the wrist. The repair could be needed because of a wrist laceration. If so, the appropriate ICD-9 code could be 718.93 (unspecified derangement of joint; forearm) for an old injury or 881.02 (open wound of elbow, forearm and wrist; without mention of complication; wrist) or 842.00 (sprains and strains of wrist and hand; wrist; unspecified site) for a current injury. Codes 881.02 and 842.00 are both rather vague, especially the latter, Johnson says. You should work with the surgical staff to get enough information to determine which is best for your situation.

Unlisted Codes: The Last Resort

When all else fails, using the unlisted procedure codes (such as 01999 [unlisted anesthesia procedures], for carriers who require anesthesia codes or the surgical unlisted code applicable to the procedure, for carriers who accept surgical codes for anesthesia) is an option.

Some experts say that the service the anesthesiologist performs is often at a higher level than the unlisted code represents, so using it can hurt reimbursement. Reserve it for situations when there are no other codes that the carrier will accept for the procedure.

Check for Local Updates

Some carriers recognize that areas such as arthroscopy and laparoscopy are continually growing, and they attempt to modify their policies accordingly. For example, a recent policy from Kemper Insurance in Long Grove, Ill., that affects several states (Alaska, Arizona, Colorado, North and South Dakota and others) reads in part, There is an increase in arthroscopic procedures being rendered today, some of which may not have assigned CPT codes. These unlisted procedures must be reported with the aggregate CPT code 29909 (unlisted procedure, arthroscopy).

The policy continues with a list of descriptors for specific arthroscopic shoulder procedures that should be included on the claim form along with the corresponding CPT code of the comparable open procedure. Using these descriptors is sufficient for identifying the procedure performed and the appropriate reimbursement amount, so the carrier does not require that operative reports also be submitted with the claim unless further documentation is requested. Arthroscopic shoulder procedures not meeting the policys description and submitted with an aggregate code must include an operative report with the claim.

Other local carriers may have similar policies regarding how to code for procedures that do not have specific CPT codes.