Anesthesia Coding Alert

If you don’t have documentation of criteria, turn to special modifiers.

Perioperative temperature management is an important PQRI reporting option for anesthesia providers. Ensure that you’ve mastered the basics so you know when to report 4250F versus 4255F, or when both codes might apply.

Understand When the Measure Applies

PQRI measure 193 (Perioperative temperature management) can be used for patients of any age who undergo a surgical or therapeutic procedure using general or neuraxial anesthesia for 60 minutes or longer.

2 exceptions: The only two exceptions apply to patients who have cardiopulmonary bypass surgery: (1) when the anesthesiologist either uses active warming to maintain normothermia during the surgery, or (2) when the provider records at least one body temperature equal to or greater than 36 Centigrade within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time.

Note: For the purposes of reporting this measure, "active warming" is limited to over-the-body active warming (such as forced air, warm-water garments, and resistive heating blankets).

How often: If your anesthesiologist is tracking measure 193, the provider should report it each time the criteria apply during the reporting period (January through December). "We used to have a six-month reporting option, but we lost that in 2012," says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. "Now the six month option is only open to registry reporting." There is no diagnosis associated with the measure.

Include All the Necessary Codes

You’ll need at least two codes on the claim whenever you report measure 193, except when the case is less than one hour (See example 3 below). The first code, known as the numerator, is a Category II code that represents the measure. The second, or denominator, is the applicable anesthesia code. The numerator options include:

4250F -- Active warming used intraoperatively for the purpose of maintaining normothemia, OR at least one body temperature equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (CRIT)

4255F -- Duration of general or neuraxial anesthesia 60 minutes or longer, as documented in the anesthesia record (CRIT) (Peri2)

4256F -- Duration of general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record. (CRIT) (Peri2)

When a case doesn’t meet the code criteria because of anesthesia technique or not reaching the required temperature, append a modifier for explanation. Your two choices are:

Modifier 1P -- Intentional hypothermia OR active warming not indicated due to anesthetic technique: peripheral nerve block without general anesthesia, OR monitored anesthesia care

Modifier 8P -- Active warming not performed OR at least one body temperature equal to or greater than 36 degrees Centigrade not achieved within designated timeframe, reason not otherwise specified.

Practice With 4 Sample Scenarios

Sometimes the best way to understand how the codes fit together is to see how they apply to real-life situations.

Example 1: The case required general anesthesia and lasted 72 minutes. Confirm that your provider recorded at least one body temperature within the specified parameters and whether your provider used active warming to maintain normothermia. Report the case as:

00XXX (the applicable anesthesia procedure code)

4250F (if the criteria for active warming or body temperature check were met)

4255F (because the case involved general anesthesia and lasted more than 60 minutes).

Example 2: The case required general anesthesia and lasted 72 minutes. The active warming and temperature criteria for the measure were not met, though you don’t have documentation of why. You’ll submit:

00XXX

4250F-8P (because the measure criteria weren’t meat)

4255F (because the anesthesia technique and length of time still qualify the case for measurement).

Example 3: The anesthesia provider administered neuraxial anesthesia during case, which lasted 54 minutes. Submit 4256F with the anesthesia code, since the anesthesia technique qualified for the measure but the time threshold wasn’t met.

Example 4: The anesthesiologist used MAC (monitored anesthesia care) or administered a peripheral nerve block during the procedure. Active warming was achieved. Include the anesthesia code and either 4256F if the case was less than 60 minutes, or 4250F-1P and 4255F if the case lasted 60 minutes or more.