Anesthesia Coding Alert

Question: Our anesthesiologist worked during a procedure to insert a defibrillator transvenously in a patient who had both acute diastolic and congestive heart failure. How should I code for this?

Montana Subscriber

Answer: For the procedure, start with 33216 (Insertion of a transvenous electrode; single chamber [one electrode] permanent pacemaker or single chamber pacing cardioverter-defibrillator). Your CPT manual may include a symbol that indicates this procedure includes moderate sedation. But you can, of course, report the anesthesiologist's deeper anesthesia services separately.

For your claim, 33216 crosses to 00534 (Anesthesia for transvenous insertion or replacement of pacing cardioverter-defibrillator).

Watch out: Although 00534 (seven units) is the appropriate anesthesia code for insertion or replacement of a pacing-defibrillator, many times physicians will perform electrophysiology studies and testing of the unit in addition to placing the leads. If this is the case, coding 00537 (Anesthesia for cardiac electrophysiologic procedures including radiofrequency ablation) -- for 10 units -- is more appropriate.

Acute heart failure may indicate that this is the first time the patient has had this condition. Start by looking under 428.3x (Diastolic heart failure). Then you'll code using the fifth digit for the acute nature of the patient's heart failure, so the final coding choice will be 428.31 (... acute).

Experts note: Coders need a basic understanding of the differences between acute, chronic, and acute on chronic heart failure. Physicians also need to be careful to specify in their notes the CHF's degree of severity and where it is located -- in the systolic or diastolic areas of the heart.

In most cases, you'll see a systolic and diastolic component, and you should look to 428.4x (Combined systolic and diastolic heart failure) for the diagnosis. Medication and histories can provide information that will help you accurately understand whether the problem is acute, chronic, or acute on chronic.

-- Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver; and Kelly Dennis, MBA, CPC, ACS-AP, with Perfect Office Solutions of Leesburg, Fla.