Anesthesia Coding Alert

Your practice will dictate how they affect you

The newest edition of ICD-9 (effective Oct. 1) includes new and revised codes for chronic renal failure, prosthetic joint repair, and dehydration/volume depletion that help justify medical necessity for anesthesia.

Much of the new codes- merit depends on the types of cases your anesthesiologists see, so you should be prepared for anything that might cross your desk. Prepare for New, More Specific Diagnoses Your job as a coder is to report diagnoses and procedures as precisely as possible to ensure accurate claims and appropriate reimbursement. Most of the ICD-9 changes taking effect in October will make that easier by adding new diagnosis categories or expanding existing ones.

Positive change: Most coders would agree that having more specific diagnoses is a positive change. Some, including Leslie Johnson, CCS-P, CPC, coding supervisor for River Oaks Imaging and Diagnostics in Houston, think the increased details are a sign of what's to come with future editions.

-Coders need to get used to choosing codes that spell out the entire condition from beginning to end instead of relying on faulty and/or misleading nonspecific codes,- Johnson says. You should be ready to treat the case -from a more three-dimensional- perspective to determine the correct codes, she says--as opposed to settling for whatever the technician, CRNA or anesthesiologist decides to write. Report Dehydration, Volume Depletion Separately Previous versions of ICD-9 had a single, catchall code for volume depletion (276.5, Volume depletion) that included a range of conditions. The new edition divides this condition into three specific codes:

- 276.50--Volume depletion

- 276.51--Dehydration

- 276.52--Hypovolemia.

The new breakdown can help your coding from both an anesthesia and pain management standpoint. Having codes that distinguish depletion, dehydration and hypovolemia from each other lets you be much more precise with the diagnosis.

Dehydration changes: Severe dehydration can interfere with a patient's metabolism and heart rate. This presents a major risk to the patient's life, which elevates the patient's physical status indicator (P1-P5). Note: Although most carriers don't reimburse extra units for higher physical status modifiers, using them does help document the seriousness of the case and the physician's risk in caring for the patient.

Fortunately, the physician can easily treat dehydration and should correct the situation before the procedure in all but the most extreme emergencies. The dehydration code might not help justify anesthesia procedures but could be a factor the physician considers when he assesses a patient for chronic pain management.

Volume depletion key: Volume depletion is a threat to the patient's life and can cause low blood pressure and high heart rate. Both dehydration and volume depletion can play a vital role when you-re coding for pain management. The patient's condition is extremely important [...]