Anesthesia Coding Alert

Every code can help justify your anesthesia provider’s service.

The initial information about updates to ICD-10 for the next year has been released, with a few diagnosis changes that could come into play for anesthesia coders.

Why it matters: There are times when the patient’s condition can affect how your provider administers anesthesia or makes anesthesia administration riskier than with an otherwise healthy patient. This, in turn, can affect which P modifier you include on the claim to document the patient’s status.

Consider the following examples of updates to ICD-10 2020 that could affect your code selection.

You’ll have four more diagnoses related to atrial fibrillation from which to choose:

• I48.11 – Longstanding persistent atrial fibrillation
• I48.19 – Other persistent atrial fibrillation
• I48.20 – Chronic atrial fibrillation, unspecified
• I48.21 – Permanent atrial fibrillation.

“Being able to assign clear diagnoses for health conditions such as these can also justify the need for anesthesia when it might not otherwise be considered necessary,” reminds Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl.

When a patient undergoing anesthesia is diagnosed with phlebitis and thrombophlebitis or with acute or chronic embolism and thrombosis, you’ll have new diagnoses that are more site specific than the current options. Each group will include eight new codes that distinguish right, left, bilateral, or unspecified locations.

• I80.24~ and I80.25~ for phlebitis and thrombophlebitis
• I82.45~ and I82.46~ for acute embolism and thrombosis
• I82.55~ and I82.56~ for chronic embolism and thrombosis.

Two other additions represent pulmonary embolism:

• I26.93 – Single subsegmental pulmonary embolism without acute cor pulmonale
• I26.94 – Multiple subsegmental pulmonary emboli without acute cor pulmonale.

Key point: “With these changes (and any diagnosis selection), be sure to pay attention to the details,” Dennis says. “When I’m auditing codes, many of the mistakes I see are based on the coder not paying attention to the slight differences such as acute versus chronic.”

Finally, if you code for pain management procedures, two revisions to related to migraine might help justify treatments:

• G43.A0 – Cyclical vomiting, in migraine, not intractable
• G43.A1 – Cyclical vomiting, in migraine, intractable.

Term check: An intractable migraine (also called a status migrainosus headache) is a migraine that lasts longer than 72 hours.

The update to ICD-10 2020 incudes 273 additions, 21 deletions, and 30 revisions. All changes will go into effect Oct. 1, 2019.