Anesthesia Coding Alert

Including supporting documentation can also help your cause.

ICD-9 Codes 2010 introduced a new V code for patients with a history of failed moderate sedation, but that didn't automatically solve your coding problems. Read on for three simple steps to correctly report ICD-9 V15.80 (Personal history of failed moderate sedation) in one of its most common uses: to support anesthesia during colonoscopy.

Scenario: A gastroenterologist wants your anesthesiologist to provide anesthesia during a patient's colonoscopy because the patient has a previously failed moderate sedation session. When the anesthesiologist completes the pre-procedure exam, he classifies the patient as P3 (A patient with severe systemic disease) because of her history of transient ischemic attack (TIA) and cerebral infarction seven months ago, without residual deficits.

1. Confirm the Original Diagnosis

Your first step in justifying the necessity for anesthesia is to understand the patient's diagnosis and condition.

"The diagnosis on the anesthesiologist's claim should follow that of the gastroenterologist," explains Kristie Brown, account specialist with Gastroenterology Associates of Pensacola in Florida. ICD-9 guidelines confirm this advice with the statement, "When a patient presents for outpatient surgery, code the reason for the surgery as the first-listed diagnosis (reason for the encounter), even if the surgery is not performed due to a contraindication" (ICD-9 Guidelines, Section IV A 1).

Potential diagnoses could include 569.3 (Hemorrhage of rectum and anus) for rectal bleeding, 564.00 (Constipation) for unspecified constipation, or others.

2. Support the Reason for Anesthesia

The patient's medical history and findings from the anesthesia exam can help justify using anesthesia services during the colonoscopy instead of moderate sedation.

Next diagnosis: Because the patient in question has a history of failed moderate sedation, list V15.80 (which is identified as a secondary diagnosis only code) after the surgical-related diagnosis. Experts say V15.80 should be enough to justify anesthesia during a colonoscopy for most payers. If you have other supporting diagnoses, however, you can also include those on the claim.

"Our Medicare billers advise that the anesthesia codes should be linked to the reason the service needed to be done with separate anesthesia," says Jan Rein, CPC, with PeaceHealth. "Medicare has a MAC [monitored anesthesia care] policy that tells you what problems qualify for MAC."

Example: The patient in the above scenario could qualify for anesthesia because of her personal TIA history, reported with a tertiary diagnosis code V12.54. Other supporting diagnoses might include the appropriate code from 490-496 (Chronic obstructive pulmonary disease and allied conditions), 332 (Parkinson's disease), or a mental health diagnosis such as 331.82 (Dementia with Lewy bodies).

Check the Payer's Policy

If your payer questions the use of anesthesia during colonoscopies, take steps before and after the procedure to increase your chances of being paid.