Anesthesia Coding Alert

Question: Our physician administered anesthesia during a debridement excision of toes; the supporting diagnosis is ischemic necrosis. I-ve submitted diagnoses 785.4 (Gangrene), 707.15 (Ulcer of other part of foot) and 707.9 (Chronic ulcer of unspecified site), but Medicare denies the claim. What diagnosis should I report?


Alabama Subscriber

Answer: For the actual diagnosis, try 709.8 (Other specified disorders of skin) or 459.9 (Unspecified circulatory system disorder). The carrier should accept either code.

Next, verify that you-re reporting the correct anesthesia code. The correct surgical code will depend on the depth of debridement; the anesthesia code changes based on the surgical code.

If the surgeon debrides to the muscle, his code is 11043 (Debridement; skin, subcutaneous tissue, and muscle) and the anesthesia code is 01470 (Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified). If the surgeon debrides to the bone, his code is 11044 (Debridement; skin, subcutaneous tissue, muscle, and bone) with the corresponding anesthesia code 01480 (Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified). Your reimbursement will be the same because both anesthesia codes are three base units, but you want to accurately report the procedure.

Verify the type of anesthesia used during the procedure. If the anesthesiologist used monitored anesthesia care, you might be missing conditions that justify the need for anesthesia. Check the carrier's MAC policy for a list of acceptable conditions, which might include diabetes, heart conditions or other issues.