Anesthesia Coding Alert

Question: I am coding for anesthesia during an endograft repair of an abdominal aortic aneurysm (CPT 34800, Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-aortic tube prosthesis). The anesthesiologist wants to charge 15 base units for the procedure, but the corresponding anesthesia code (01926, Anesthesia for therapeutic interventional radiologic procedures involving the arterial system; intracranial, intracardiac, or aortic) is 10 units. The alternative anesthesia code (00770, Anesthesia for all procedures on major abdominal blood vessels) is 15 units. How should I determine the difference in these base units?

New York Subscriber

Answer: An endograft repair can be a surgical procedure or an interventional radiology procedure, depending on the situation and the physician's technique. That's why the surgical code 34800 lists both options as appropriate anesthesia codes.

Yes, code 01926 is for therapeutic interventional radiology, and "therapeutic" is curative treatment or therapy, but I would hesitate to use 01926 for the procedure you describe. The alternative anesthesia code, 00770, gives a more definitive description of the primary procedure code 34800 because the abdominal aorta is a major abdominal blood vessel. Code 00770 also represents a more intense procedure that could convert to an open procedure in the operating room, so that's another reason it may be more appropriate.

In determining which code is more appropriate, review the documentation and operative report or ask the physician to clarify what he or she provided service for: a surgical procedure that crosses to anesthesia code 00770, or an interventional radiology procedure that crosses to code 01926.You may also want to work with the physician to set guidelines for when you code each type of procedure. For example, use 01926 if the procedure is straightforward, is within a certain time frame, there's no rupture of dissection, etc. Use 00770 for more complex procedures.