Anesthesia Coding Alert

Although coding resources abound, anesthesia coding tools sometimes seem scarce. In addition to purchasing CPT, HCPCS and ICD-9 manuals annually, Emma LeGrand, CCS, coding supervisor with North Jersey Anesthesia Associates, P.C., in Florham Park, and Robin Fuqua, CPIC, anesthesia coder for Anesthesia Consultants of California in Escondido, recommend the following resources for anesthesia professionals:
 
Note: Purchasing information is included at the end of each entry. Most resources are also available at local bookstores except the American Society of Anesthesiologists (ASA) publications.

ASA Crosswalk. Verify base units and corresponding anesthesia codes for procedures with the Crosswalk. Use it to identify procedures where anesthesia is unwarranted and ASA codes that CPT omits. For a copy, contact the ASA
at 847-825-5586.
 

Codelink for Anesthesiology. Codelink offers common ICD-9 for CPT codes, which is helpful when you can't find a diagnosis in the ICD-9 manual. Check a physician's diagnosis with Codelink. If the diagnosis is unlisted, consult the physician for a more accurate one. Purchase online at www.amazon.com.
 

Diagnostic Coding Essentials. This guide breaks down ICD-9 codes numerically with thorough explanations including the exact location affected and whether a diagnostic code is gender-specific. It also breaks out the M codes for pathology and gives diagrams when appropriate. For example, a patient's diagnosis may be "malignant lesion, left breast, right upper-outer quadrant." The coder assigns 174.4 (malignant neoplasm of female breast, upper-outer quadrant). After further checking, the coder sees that the patient is a male, so the gender-specific code 175.9 (malignant neoplasm of male breast, other and unspecified sites of male breast) is the appropriate diagnosis. Buy from www.sunrize.com/icdessentials.html.
 

Modifiers Made Easy. This comprehensive resource for CPT and HCPCS modifiers gives coding tips and scenarios on how to use modifiers. The book is organized by specialty rather than by modifier. Visit www.hcfa-1500-forms.com/coding-books/modifiers-easy.html to purchase a copy.
 

ASA's Relative Value Guide (RVG). The ASA's Relative Value Guide, published each spring, contains ASA changes and reimbursement values. Call 847-825-5586.

Medical dictionaries and anatomy guides can be valuable tools for the coding professional. Some of LeGrand's and Fuqua's favorites include:
 

Taber's Cyclopedic Medical Dictionary. Descriptive definitions and references such as lab values, anatomy information and drug interactions make this an invaluable tool. Many physicians use their own descriptions or comments on lab values. Taber's can confirm whether a lab test is outside normal limits. Dorland's and Stedman's medical dictionaries also receive high marks.
 

Gray's Anatomy. Use this resource when you can't match a doctor's diagnosis with CPT or ICD-9 wording. Gray's Anatomy can explain that a physician's note "neuritis of the fifth cranial nerve" relates to the trigeminal nerve.
 

Physician's Desk Reference. The PDR offers descriptions of analgesic agents. Some new medications such as Bupivacaine are not included in HCPCS. Finding the medication's description in PDR can help the coder bill properly and receive adequate reimbursement.
 
Medical references are available at www.amazon.com.

Many coders find help in cyberspace. A few of the popular choices for coding help on the Internet include:
 

Local Medicare carriers' Web sites. These sites include the latest policy changes. Use e-mail help and directories to locate the right person to help with your question. A list of sites by states is available from CMS' Web site at www.hcfa.gov/medicare/incardir.htm#1. You can also find out if your commercial carriers have Web sites to keep you abreast of changes.
 

The American Society of Anesthesiologists' Web site (www.asahq.org). Practice management articles, changes in the ASA's RVG and other news on anesthesia care and reimbursement make this a good resource.
 

The American Association of Nurse Anesthetists' Web site (www.aana.com). This site often has information about new coding and billing changes. Users need a password to access some of the information, but other information is posted in the site's public area.
 

Local medical review policies (www.lmrp.net). Medicare makes all LMRPs available on this site, where you can search for an LMRP or compare your state's LMRP for a procedure to other states'.
 

Local medical societies. If the physicians you code for are members of the local medical society, ask them to check periodically the "members only" section for information on coding and reimbursement.
 

The Coding Institute Web site (www.codinginstitute.com). Visit this site to join speciality-specific discussion groups, receive coding help and access publication archives.
 

Global Anesthesiology Server Network (www.gasnet.org). This site offers discussion groups, coding solutions and educational materials.

Also important are new versions of Correct Coding Initiative edits that are published quarterly. Anesthesia & Pain Management Coding Alert informs readers of pertinent changes after analysing data purchased from the National Technical Information Service.
 
By making annual notations in their CPT book, coders can consolidate the most valuable information into one primary, user-friendly source. Include common abbreviations and skin diagnoses. Mark base volumes, diagnoses, and ASA crossover codes. Highlight the diagnosis in the descriptor and write the corresponding ICD-9 code.