Anesthesia Coding Alert

Question: How does tumescent anesthesia differ from other anesthesia techniques, and how should I code for it? Do different documentation guidelines apply or are there other third-party issues to consider?

Oklahoma Subscriber

Answer: When the physician administers tumescent anesthesia, he injects a liquid solution into the fat tissue located directly under the skin (as opposed to injecting the anesthetic agent directly into the bloodstream). The body slowly takes in the anesthesia, which then provides a localized effect. The physician might perform multiple injections within a few inches on either side of the vein.
 
Tumescent does not usually require the services of an anesthesiologist; the surgeon usually administers it instead. If the anesthesiologist did administer tumescent anesthesia, you can't bill anesthesia services for local anesthesia.
 
When it's time to code, look only at the operative report and diagnosis, not the "type" of anesthesia. If your physician placed the catheter, use the appropriate surgical code based on the procedure performed. If your physician provided anesthesia after someone else placed the catheter, report the anesthesia code that corresponds to the appropriate surgical code.
 
The only time you worry about the type of anesthesia is when the carrier requests documentation of MAC (monitored anesthesia care). Report these cases with modifiers -QS (Monitored anesthesia care service) and  -G8 (Monitored anesthesia care [MAC] for deep complex, complicated or markedly invasive surgical procedure) or  -G9 (Monitored anesthesia care for patient who has history of severe cardiopulmonary condition) if the carrier requires it.

Even so, reporting these modifiers doesn't change your bottom line because carriers don't factor in anesthesia technique or the drugs used when they determine reimbursement.