Anesthesia Coding Alert

Question: What code should I report for excision of arteriovascular malformation in the chest wall? The physician performed the procedure percutaneously.

Vermont Subscriber

Answer: Your best code for this excision is 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified). Why? Because the chest wall -- the location of the patient's malformation -- is muscle. The surgeon performed a skin/muscle procedure, so 00400 applies.

Some coders wonder if 00560 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump  oxygenator) or 00562 (... with pump oxygenator) might apply to this procedure. Because the chest wall is muscle and does not involve the heart or great vessels, however, 00400 still is the more accurate choice.

Extra note: Physicians sometimes treat malformations with interventional radiology techniques. Because the procedure you describe involves the arterial system, you would report an interventional radiology treatment approach with either 01924 (Anesthesia for therapeutic interventional radiological procedures involving the arterial system; not otherwise specified) or 01930 (Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system [not to include access to the central circulation]; not otherwise specified).

Codes 01924 and 01930 carry base unit values of 6 units and 5 units, respectively; code 00400 has a base unit value of 3.

Verify the provider's approach to ensure you report the most accurate code and corresponding base value for the procedure's difficulty.