Anesthesia Coding Alert

Signs and symptoms may sometimes be your best -- or only -- choice Choosing the right CPT procedure code is the first step to ensure your physician gets paid for the work she does, but if you fail to attach the correct diagnosis code, you may be in jeopardy of receiving denials. Follow these expert recommendations to ensure you're properly coding patients' signs, symptoms and diagnoses -- and keeping your claims on track. 1. Watch for 4th- and 5th-Digit Requirements Correct coding requires that you report procedures -- and their associated diagnoses -- as specifically as possible. Translation: Your anesthesiologist or pain management specialist should assign the most precise ICD-9 code to a service. You cannot justify a service with a four-digit diagnosis code when carriers or ICD-9 requires a more specific five-digit code to describe the patient's condition. "Using the fourth or fifth digit when it is required -- or just when you do have that information -- is an important concept to follow," says Karen Marsh, RN, MSN, president of Kare-Med Consulting in Jensen Beach, Fla. Make sure you review the entire record when determining the specific reasons for the encounter and the conditions the physician treated, she says. "Using a fourth or fifth digit for your diagnosis in some instances justifies the medical necessity for using an anesthesiologist to sedate patients," says Emma LeGrand, CCP, CCS, coding supervisor for New Jersey Anesthesia/Health Network Management in Florham Park. Example: A gastrointestinal (GI) specialist evaluates a patient due to complaints of chronic abdominal pain. The physician decides to perform an esophagogastroduodenoscopy (EGD) and calls the anesthesiologist to sedate the patient because of anxiety (300.00, Anxiety state, unspecified). The test is positive for irritant gastritis with hemorrhage (535.41, Other specified gastritis; with hemorrhage). "Some carrier policies will reimburse and justify the need for an anesthesiologist if the patient has gastritis with hemorrhage because this is an added risk factor," LeGrand says. Caveat: If you submit the claim without the fifth digit that identifies the hemorrhage or if you submit it with the wrong fifth digit such as 535.40 (... without mention of hemorrhage), LeGrand says, you risk losing reimbursement for your anesthesiologist's services. Code 300.00 detail: You can report the patient's anxiety as a secondary code, but it's not usually enough to warrant medical necessity for an anesthesiologist. Some carriers might accept it as justification, however, so check your guidelines. Tip: Follow your physician's documentation when selecting diagnoses. If the medical record does not allow you to code to the required level of specificity, check with the reporting physician for guidance.
2. Call on Signs and Symptoms When your physician provides a confirmed diagnosis, you should always code that diagnosis [...]