Anesthesia Coding Alert

Question: Our anesthesiologist administered general anesthesia during a bronchoscopy and mediastinoscopy to remove the patient's lung nodule. He used fiberoptic confirmation when placing an A-line and double lumen tube. He also inserted an epidural for post-op pain relief. How should I code this case?


Utah Subscriber
 

Answer: First, verify whether the anesthesiologist used one-lung ventilation during the procedure. If he did, report 00529 (Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy utilizing one-lung ventilation) for the main procedure.

If the physician did not use one-lung ventilation, report 00528 (... mediastinoscopy and diagnostic thoracoscopy not utilizing one-lung ventilation).

Add 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) for the A-line insertion and append modifier 59 (Distinct procedural service) because it's an additional service.

Most carriers state that procedure codes include the double lumen tube placement and fiberoptic intubation, so you shouldn't report these separately. Some carriers do allow you to report 01999 (Unlisted anesthesia procedure[s]) for the double lumen tube placement, so check your guidelines.
  
Verify where the anesthesiologist placed the epidural before coding for it. You'll report either 62318 (Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) or 62319 (... lumbar, sacral [caudal]). Add modifier 59 to 62318 or 62319 because the epidural is for post-op pain management.
 
Some carriers require a separate diagnosis to justify post-op pain management. If yours does, your physician should note "Epidural placed at surgeon's request for post-op chest pain control" in the anesthesia record. Supporting diagnoses could include 786.50 (Chest pain, unspecified), V45.89 (Other postprocedural status; other), and V58.49 (Other specified aftercare following surgery).