Anesthesia Coding Alert

Take easy steps to lower claim problems and retain or increase revenue.

Denials got you down -- financially or otherwise? Here are some coding and “housekeeping” tips to dispel the anesthesia and pain management denial blues.

Tip 1: Beware Messy Bundled Anesthesia Services

Most anesthesia services are bundled with other services. According to Cindy Lane, CPC, CHCC, with Advanced Coding Solutions LLC in White House, Tenn.,you need to stay up to date with the most recent Correct Coding Initiative (CCI) edits. Currently, anesthesia includes services such as:

• transporting, positioning, prepping, draping of the patient for satisfactory anesthesia induction/surgical procedures

• placement of external devices necessary for cardiac monitoring, oximetry, capnography, temperature, EEG, CNS evoked response, Doppler flow

• placement of airway (endotracheal tube, orotracheal tube, etc.) or naso-gastric or oro-gastric tube

• laryngoscopy (direct or endoscopically) for placement of airway

• intraoperative interpretation of monitored functions (blood pressure, heart rate, respiration, oximetry, EEG,temperature, etc.)

• interpretation of laboratory determinations (arterial blood gases such as pH, pO2, pCO2, bicarbonate, hematology, blood chemistries, lactate, etc.) by the anesthesiologist/CRNA

• placement of peripheral intravenous lines necessary for fluid and medication administration

• insertion of urinary bladder catheter

• blood sample procurement through existing lines or requiring only venipuncture or arterial puncture

• nerve stimulation for determination of level of paralysis or localization of nerve(s).

Codes for EMG services are for diagnostic purposes for nerve dysfunction. The medical record must include a complete diagnostic report before you can submit these codes, Lane says.

What you can bill: The anesthesia service does not include some line placements, which means you can code separately when you have supporting documentation, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y.

These include:

• arterial lines -- 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) or 36625 (... cutdown)

• central venous pressure lines -- 36555 (Insertion of non-tunneled centrally inserted central venous catheter;younger than 5 years of age) or 36556 (... age 5 years or older)

• Swan-Ganz lines -- 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes).

Tip 2: Match Your Modifiers to Avoid Misuse

Your practice needs a checks-and-balances system to ensure all claims are correct. If your physician or specialist provides CPT codes with her documentation,that can be helpful, but you should be prepared to check for bundled codes.

For example: Your physician provides a service bilaterally and includes modifier 50 (Bilateral procedure) on the claim. Often you will include the modifier, but appending it should not be reflexive. Remember there are CPT codes which already represent bilateral services, so you wouldn’t report modifier 50 with them.

Pain management coders see this with procedures such as kyphoplasty (22523-22525, Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, one vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty]. . .). The code description indicates that these services are inherently bilateral, so billing them with modifier 50 appended would be incorrect and would lead to a quick denial.

Final tip: Obtain and organize resources that list codes you can report together and those you cannot. Every anesthesia and pain management coder needs these references on her desk to help ensure accurate billing every time.