Anesthesia Coding Alert

Question: How should I separate anesthesia charges for nasal repair procedures (such as 30465 or 30520) from a rhinoplasty (30400) when the surgeon performs all services during a single session?

Arizona Subscriber

      Answer: Many coders recommend that you separate multiple services such as these by surgery time, especially when you'll seek reimbursement from both the carrier and patient.

      The nasal repair and rhinoplasty codes both cross to anesthesia code 00160 (Anesthesia for procedures on nose and accessory sinuses; not otherwise specified). Ask your anesthesiologist to document the time for each procedure separately. For example:

      •  Repair of nasal vestibular stenosis (e.g., spreader grafting, lateral nasal wall reconstruction) -- 30465:  60 minutes, insurance

      •      Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip -- 30400: 35 minutes, self-pay.

      Documenting the time for each service will simplify your coding and allow you to bill each party accurately. Submit the entire procedure to the carrier, and then wait for its denial of the rhinoplasty because it won't consider the procedure medically necessary. Once you have that denial, bill the patient for the remaining balance.

      Helpful hint: Prior to surgery, have the patient complete an advance beneficiary notice (ABN) that states she will be responsible for payments the carrier denies.

            Watch your units: Remember that if you send two bills for the same anesthetic, only one should include the procedure's start-up units. Include the five base units and time on the insurance carrier's claim, and bill the patient only for the time associated with the rhinoplasty.