Anesthesia Coding Alert

Most anesthesiologists and CRNAs prepare for surgical cases knowing exactly what type of service is planned for the patient. The anesthesia coder also knows what procedure has been scheduled and what code should be applied. But what happens when the surgeon actually performs a service thats different from what was anticipated?

This situation occurs more often than not, says
Barbara Johnson, CPC, MPC, of Loma Linda University Anesthesiology Medical Group in California. The patient may be scheduled to have one procedure, she says, but the surgeon realizes that something a little different should be done instead. It may not be a big change, and the anesthesia provider may not even realize that the procedure has been modified. Chances are it doesnt make a difference to the anesthesia provided during the surgery, but it can make a huge difference when its time to code it for reimbursement.

Surgery Code is Key to Getting Paid

Thats because some insurance carriers wont accept an anesthesia code alone for the surgerythey want the CPT code for the actual surgery instead. The situation becomes more complicated when the procedure is altered slightly and requires a different code than the anesthesiology office anticipated. This can happen, for example, when an exploratory laparotomy (49000, exploratory laparotomy, exploratory celiotomy) becomes a colon or small bowel resection (56348, intestinal resection, with anastomosis), or when an ovarian cystectomy (58925) becomes an oophorectomy ( CPT 58940 , oophorectomy, partial or total, unilateral or bilateral).

The key is to be sure the anesthesiology code matches the surgeons code when the paperwork is submitted, Johnson says. That can be hard to do partly because of a lack of communication between the anesthesia and surgery coders and a lack of communication between the surgeons and anesthesia providers as well.

Tips for Matching Codes

So whats a coder to do? Johnson and Tami Maxey, office manager of Independent Billing Agency in Poplar Bluff, MO, a billing agency for anesthesiology, respiratory therapy and medical practices, offer these tips for ensuring that the anesthesia and surgical codes for reimbursement match:

1. Develop a system for seeing or receiving the operative reports so youll have the most recent information on the case before you file the claim. For example, if the anesthesia team routinely works at one hospital, get to know key people in the OR or Medical Records departments who can help you get copies of the reports. Keep track of surgical cases on your own calendar and post reminders to yourself to follow up on cases.

2. Work from an accurate OR report, if one is available from the hospital or the surgeons office, so the terminology you use when filing the claim will match the cases original documentation.

3. Call the surgeons office for specific information related to the case to clarify questions you have about the OR report, or if you arent able to get a copy of the OR report.

4. Turn in an anesthesia record along with the patients face sheet (medical history, physical and demographic information) and surgical report, so your insurance carrier can cross match the services provided by both providers and reimburse you accordingly.

5. Include as many details about the procedure on the anesthesia report as possible to ensure that the insurance carrier knows what level of service was provided. For example, noting that a lesion was 6 cm and malignant instead of simply stating that a lesion was removed will help you get the appropriate reimbursement.

Anesthesia Reimbursement is Slow

Anesthesia is often the smallest charge related to the case, yet often is reimbursed slower than the other specialties, according to Johnson. Many carriers wait to pay anesthesia until after the surgeons and hospital bills are received. Youre doing great if a claim that goes through the first time is paid in 45 to 60 days, and 60 to 90 days is acceptable. But if a claim is held up or denied because of mismatched codes, it can take up to 180 days to be paid if you have to resubmit it. Call the surgeons office as soon as possible to get their codes and get the claim back in the system again.

Tracking down the actual surgical code for a particular case can be challenging, but is well worth it, Maxey says. Taking the time to file it with the surgeons code up front and including specific details about the procedure can really save you time and headaches in
the long run.