Anesthesia Coding Alert

Surgery equipment and procedures are changing so quickly that the CPT is not able to keep up with some of the advances. This leaves some procedures without a specific code for billing purposes. How does this affect anesthesiologists? Some insurance carriers do not accept an anesthesia code alone for the surgerythey want the CPT code for the actual surgery instead. But anesthesiologists can get reimbursed for procedures that lack codes by using the codes for similar procedures or using the unlisted procedure code.

Which tactic is used may depend on the carrier. Check with your local carrier for guidelines on how to handle these types of procedures, and whether they require surgical codes (as in the examples below) or anesthesia codes for the procedures performed.

Code as Close as You Can

One area that many coders believe is lacking in appropriate codes is arthroscopy, says Deborah K. Hecht, CCS-P, a coding specialist with Professional Anesthesia, an 11-member private-practice anesthesia group with 45 certified registered nurse anesthetists (CRNA) in Akron, Ohio. This is especially true for procedures that are being done on the hands and fingers, she says. These procedures are being done more and more often because they are easier than ever to do and the patients recover so much more quickly. But how do you code for them when theres nothing in CPT that really applies?

One example of this situation is a rotator cuff repair, Hecht continues. Were doing them arthroscopically, but theres not a CPT code specific to it. Code 23410 is for the repair of an acutely ruptured rotator cuff. Code 29819 is for arthroscopy of the shoulder with the removal of a loose or foreign body. Neither code exactly covers the situation.

In that type of scenario, coding professionals can either be correct to the procedure or to the codeyou cant be correct to both. Each case is often considered individually, and the procedure is filed based on which code seems to be a little more appropriate for what was done.

Hechts solution is to file with the closest matching code possible without exceeding the procedures worth. I try to put something as close as I can without going over the top, she explains. Sometimes well use a code thats fairly on target and add modifiers to help make it more accurate. Of course, anytime we use modifiers we include all the supporting documentation to show why they were necessary.

For example, Hecht says that a physician may perform an evaluation and management (E/M) service on a new or established patient (code 99245 or code 99255, depending on whether the service is inpatient or outpatient) that takes longer to complete than is standard. If so, [...]