Anesthesia Coding Alert

Question: During a recent audit in our department, I was marked down for having too many diagnosis codes that the auditors felt did not affect anesthesia. For example, the auditor thought that smoking, hyperthyroidism, and diabetes were not important in the anesthesia process. If my provider documents a diagnosis in the pre-op evaluation, I enter it in the charges. I don’t believe it is my responsibility to determine if that comorbidity affects the anesthesia. What’s your suggestion for handling this?

Michigan Subscriber

Answer: Diagnoses such as smoking (F17.200), hyperthyroidism (E03.9), and diabetes (E11.9) technically do not fall on the list of Complications and Comorbid Conditions that Medicare provides for MS-DRG classifications. Diagnoses on this list that would be considered to add to the complexity and affect DRG assignment are more specific. For example, the codes on the list that are related to diabetes are much more detailed – and higher level – than E11.9. Some of these include:  

• E08.52 – Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene
• E09.52 – Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene
• E10.52 – Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene.

Certain medical policies might include conditions that would meet the criteria for the procedure to be covered under general anesthesia. Always check with your payer for information on what they cover and follow those guidelines as much as possible (while still choosing codes that accurately reflect your provider’s documentation).

Important to note: While other specialties may code all listed diagnosis codes, it is not necessary when billing anesthesia services. Some practices believe only the reason the patient is having anesthesia is necessary to report to the insurance company, unless the coder is trying to explain a physical status modifier or as a reason for the patient having Monitored Anesthesia Care (MAC) by reporting co-morbidities. For example, if the patient’s listed diagnoses in the pre-anesthesia evaluation are Cholelithiasis, without cholecystitis or obstruction (K80.20), smoking (F17.200), hyperthyroidism (E03.9), and diabetes (E11.9), you would only code K80.20 along with 00790 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified).

Although smoking, hyperthyroidism, and diabetes are important to your anesthesia provider, these codes are not necessary to process your claim for anesthesia services. Requiring anesthesia coders to capture these additional diagnosis codes takes additional time and leaves room for making errors on codes that weren’t important to capture. You should follow your practice policy and only code the information pertinent to the anesthesia services.

The auditor may have compared your productivity with other coders and seen this as an issue. Particularly if you are the only coder in the department reporting these additional diagnosis codes. However, in my personal opinion the auditor should not count your coding as incorrect as long as the codes were accurate.