Anesthesia Coding Alert

Question: Revascularization procedures for codes 37220-37234 can be performed as either open or percutaneous surgeries. If the artery is exposed and nicked, is that considered a percutaneous approach that would call for the 0192X anesthesia codes?  What is meant by an "open" approach? Does the artery have to be fully exposed and not just nicked? What kind of documentation is needed for us to report either 00880 or 01270 as the second choice for anesthesia codes?

Oregon Subscriber

Answer: Physicians are now performing many interventional radiological percutaneously. The term "percutaneous" means the procedure is performed through the skin, rather than through an open retroperitoneal or midline surgical incision. Documentation will show the procedure is performed through a thin, flexible tube (catheter), threaded through a blood vessel. The physician makes a small incision and inserts a thin guide wire that he threads through the artery to the blockage. A catheter is passed over the guide wire and the revascularization procedure is performed through the catheter, typically using angiographic guidance.

The anesthesia codes for percutaneous procedures (01924 -- 01933) have lower base values than the more difficult and invasive open procedures. Unless the artery was damaged and required an open repair, a nicked artery in itself is not an indication of an open surgical technique.