Anesthesia Coding Alert

Search beyond ‘anesthesia’ for codes that could affect your claims.

The first official update to ICD-10 will take place October 1, with thousands of code additions, deletions, and revisions going into effect. Final tweaks will be announced later this summer, but here’s a quick look at some changes that could affect your anesthesia coding.

Anesthesia Specific Changes Are Few

If you search the CDC’s file for descriptors specific to anesthesia, you’ll only find one revision and four additions.

Diagnosis P04.0 (Newborn [suspected to be] affected by maternal anesthesia and analgesia in pregnancy, labor and delivery) will be revised to “Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery.”

Explanation: Coding notes for the current version of ICD-10 explain that P04.0 covers situations where the newborn is suspected to be affected by reactions and intoxications from maternal opiates and tranquilizers administered during labor and deliver. The updated code will likely reflect the same situation, without the vagueness of “suspected” in the descriptor.

Three of your new diagnoses related to anesthesia are for the same situation, differentiated by the level of encounter:

• T88.53XA – Unintended awareness under general anesthesia during procedure, initial encounter
• T88.53XD – … subsequent encounter
• T88.53XS – … sequela.

A new, related diagnosis will be Z92.84 (Personal history of unintended awareness under general anesthesia). ICD-9 had an “unspecified” diagnosis for this (V15.89, Other specified personal history presenting hazards to health). The 2016 edition of ICD-10 doesn’t include a diagnosis specific enough to this situation, so the addition will be welcome – and used more often than some people might think.

Case in point: According to the American Society of Anesthesiologists, this experience – known as intraoperative awareness or anesthesia awareness – is estimated to occur about one to two times for every 1,000 uses of general anesthesia. Even though most patients do not experience pain due to intraoperative awareness, it obviously can be a disturbing situation.

Skim Other Specialties for Applicable Diagnoses

Since anesthesia providers work with patients who have procedures covering every part of the spectrum, you could find yourself reporting virtually any ICD-10 code. Some diagnoses changes reflect conditions that can affect how your provider administers anesthesia, so you’ll want to familiarize yourself with those.

For example, three new diagnoses related to hypertension might help justify the need for anesthesia in unusual circumstances or help support the assignment of a higher-level physical status modifier:

• I16.0 – Hypertensive urgency
• I16.1 – Hypertensive emergency
• I16.9 – Hypertensive crisis, unspecified.

Know the differences: Kelly D. Dennis, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla., shares the distinctions between these hypertensive conditions, based on information from the Mayo Clinic.

A hypertensive crisis is a severe increase in blood pressure that can lead to a stroke. It’s divided into two categories: urgent and emergency. When a patient experiences an urgent hypertensive crisis, her blood pressure is extremely high, but the physician doesn’t suspect any organ damage. In an emergency hypertensive crisis, the patient’s blood pressure is extremely high and has caused damage to her internal organs. An emergency hypertensive crisis can be associated with life-threatening complications.

Knowing that a patient is dealing with either of these situations could affect how your provider administers anesthesia, Dennis says.

You’ll also want to spend time sorting through the numerous additions to childbirth diagnoses. The complications mentioned as complicating childbirth could also change your provider’s anesthesia plan. A few examples include:

• O11.4 – Pre-existing hypertension with pre-eclampsia, complicating childbirth
• O12.04 – Gestational edema, complicating childbirth
• O14.4 – Severe pre-eclampsia complicating childbirth
• O16.4 – Unspecified maternal hypertension, complicating childbirth.

Other areas with extensive changes worth noting are:

• Detailed fracture codes based on the type, anatomic site, and encounter
• Embolism or thrombosis due to internal prosthetic devices or implants
• Embolism or hemorrhage due to vascular prosthetic devices or implants
• Post-procedural hemorrhage
• Cerebral infarction due to embolism or thrombosis

Good news: The changes are massive, but not too difficult to understand once you dig in. For many conditions, the various diagnoses are only differentiated by the level of encounter (initial, subsequent, or sequela). Once you learn how to determine that information for the code’s seventh character, reporting the conditions gets much easier.