Anesthesia Coding Alert

New study from ASA highlights new ways to help certain surgery patients. 

Many factors can contribute to a patient’s risk of chronic pain after surgery, which is why anesthesia providers are continually exploring ways to understand those variables beforehand. A new study published in the Online First edition of Anesthesiology shares a new planning tool that can help identify your patients’ risk of chronic pain after surgery.

“Our study rigorously examined patients’ risks of chronic postsurgical pain,” said lead study author Antonio Montes Perez, M.D., Ph.D., in a statement from the American Society of Anesthesiologists (ASA). “We sought a tool that would reliably predict a patient’s risk preoperatively, at the time surgery is being planned. We developed a risk scoring system that can be used before surgery, when care planning and preventive measures are critically important.” 

The researchers followed 2,929 patients undergoing three common types of surgery (hernia repair, hysterectomy, and thoracotomy) for two years, assessing their pain at four, 12 and 24 months after surgery. The study demonstrated that there is substantial risk of chronic pain after these surgeries, with 18 percent of the patients developing chronic pain after four months, and 5.2 percent still experiencing chronic pain after 24 months.  

The scoring system was developed based on six predictors among the patients in the study:  

• Type of surgery 
• Age 
• Physical health status 
• Mental health status 
• Preoperative pain in the surgical area 
• Preoperative pain in another area. 

According to Montes, risk scoring facilitates informed patient-physician discussion of strategies so together they can plan to use the most appropriate pain relief techniques during the post-op period and set a pain monitoring schedule and follow-ups.  

“This scoring system improves the way we examine patients prior to surgery, which is based on an extensive physical examination rather than just clinical factors,” said Dr. Montes. “As far as genetic influence, additional research should be conducted to determine whether or not other genetic factors not considered in this study contribute to chronic pain after surgery.

Code Successfully for the Procedure and Post-op Care 

When reporting the procedures the study patients had, you’ll submit the following anesthesia codes: 

• 00750-00756 (Anesthesia for hernia repairs in upper abdomen …) for hernia repair in the upper abdomen or 00830-00836 (Anesthesia for hernia repairs in lower abdomen …) for lower abdomen hernia repair 

• 01962 (Anesthesia for urgent hysterectomy following delivery) or 01963 (Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care) for hysterectomy. Another reporting option is 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery [this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor]) with +01969 (Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]) for hysterectomy 

• 00541 (Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum [including surgical thoracoscopy]; utilizing 1 lung ventilation) or 00542 (Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum [including surgical thoracoscopy]; decortication) for thoracotomy. However, if your provider uses an anterior transthoracic approach for anesthesia of the thoracic spine and cord, CPT® directs you to see codes 00625 (Anesthesia for procedures on the thoracic spine and cord, via an anterior transthoracic approach; not utilizing 1 lung ventilation) and 00626 (… using 1 lung ventilation). 

When the anesthesiologist handles postoperative pain management, remember to get a written request from the surgeon for your provider’s care. Acute pain management care could involve either a single injection or continuous catheter. For example, if your physician administers a pain management injection after the patient’s shoulder surgery, you might report 64415 (Injection, anesthetic agent; brachial plexus, single) or 64416 (... brachial plexus, continuous infusion by catheter including daily management for anesthetic agent administration). 

Code 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) applies when the anesthesia provider starts an additional infusion or bolus in a previously placed epidural catheter. Patients typically undergo this type of administration for a two-day intrathecal pump trial or an epidural infusion procedure. 

Tip: Ask your providers to document their daily management of the epidural in the patient’s progress notes. Having specific notes will support coding 01996 for each day. 

Resource: For more on coding post-op pain management, see “Follow These Do’s and Don’ts of Reporting 01996” in Anesthesia Coding Alert, Vol. 17, No. 2.