Anesthesia Coding Alert

Plus: You might need to include modifier 22 on your claim.

Sometimes your anesthesia providers need to be diligent in documenting a patient’s underlying medical conditions before being reimbursed for services that might not always require anesthesia. Such can be the case, for example, if at patient diagnosed with Parkinson’s disease is scheduled for an MRI.

The old way: When you still coded from ICD-9, you had two diagnosis choices for patients with Parkinson’s: 332.0 (Paralysis agitans) and 332.1 (Secondary Parkinsonism). The options for both these codes expanded in ICD-10, which will allow you to report the patient’s condition more accurately. 

The new way: Diagnosis 332.0 splits into two options under ICD-10. The first, G20 (Parkinson’s disease), is self-explanatory and is a valid three-character code in ICD-10. The second, G21.4 (Vascular Parkinsonism), is for a separate condition that’s similar to Parkinson’s. You’ll report G21.4 when the physician determines that multiple small strokes have produced the symptoms of Parkinson’s disease in a patient.

Secondary Parkinsonism is similar to Parkinson’s disease, but the symptoms are caused by certain medicines, a different nervous system disorder, or another illness. You’ll have six choices to replace 332.1 for secondary Parkinsonism in ICD-10, with each explaining the underlying cause of Parkinson’s. They are: 

• G21.11 – Neuroleptic induced parkinsonism
• G21.19 – Other drug induced secondary parkinsonism
• G21.2 – Secondary parkinsonism due to other external agents
• G21.3 – Postencephalitic parkinsonism 
• G21.8 – Other secondary parkinsonism
• G21.9 – Secondary parkinsonism, unspecified.

Coding notes: As you can tell by the ICD-10 descriptors, providers will need to document more details about the patient’s condition and underlying causes so you can choose the most accurate diagnosis. Start working with them now to include those details so you’ll be prepared when ICD-10 goes into effect in October 2015. 

Understand the condition: Parkinson’s disease is a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movement. It primarily affects middle-aged and elderly people, and scientists believe it is associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine. The tremors and other movement issues associated with Parkinson’s are why the patient might need to be sedated for MRIs or other standard procedures. Be sure to also include modifier 22 (Unusual anesthesia) on the claim with a documented explanation for why anesthesia services were medically necessary.

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