Anesthesia Coding Alert

Question: I'm a CRNA, but recovery room nurses process our procedure codes. The program doesn't let us insert add-on codes (for extremes of age, emergencies, etc.). How can we incorporate these add-on codes, and how can we educate the billing office on the benefits of changing this way of coding our anesthesia services?

Minnesota Subscriber

Answer: First, you might be missing some revenue by not including qualifiers such as +99100 (Anesthesia for patient of extreme age, younger than 1 year and older than 70 [list separately in addition to code for primary anesthesia procedure]) or +99140 (Anesthesia complicated by emergency conditions [specify] [list separately in addition to code for primary anesthesia procedure]). Although some carriers do not pay for qualifiers, some do -- and you should be reimbursed accordingly.

Another consideration: Are the nurses certified coders? If not, you might be missing revenue or might be submitting inaccurate claims. The anesthesiologist or CRNA might not know everything the surgeon does during the procedure, so you should study both providers' reports to reach the best anesthesia code.

If you can show that the recovery room nurses are improperly coding your cases, you could be dealing with fraud -- even if it's unintentional. Showing that, along with missed revenue, might help you get the system changed. You should be able to review the nurse's codes, add other services such as line placement or postoperative pain management, and approve the bill before it's submitted to the carrier.