Anesthesia Coding Alert

It may not crop up in every anesthesiologist's day, but anesthesia for pelvic procedures has undergone coding changes that every anesthesia coder should know how to apply. Here's the latest on these unique procedures.

There are a number of CPT anesthesia codes dealing with pelvic injury procedures, including these:

• 01120 -- Anesthesia for procedures on bony pelvis

• 01170 -- Anesthesia for open procedures involving symphysis pubis or sacroiliac joint

• 01173 -- Anesthesia for open repair of fracture disruption of pelvis or column fracture involving acetabulum.

Patients sustaining severe pelvic injuries can suffer impact so forceful that the pelvic circle is disrupted. Anesthesia for patients with this problem is significantly different from that of most patients receiving anesthesia for other hip procedures. Here's what you need to know to determine which code to apply to your claim.

Code "01120 encompasses a significant range of procedures on the bony pelvis in general," says Cindy Lane, CPC, CHCC, of Advanced Coding Solutions, LLC, in White House, Tenn.

"It covers both open and closed procedures and includes bone aspirations, debridements, fracture treatments, and others," Lane says.

Get hip: Often, patients with a disrupted pelvic circle are multiple-trauma victims. They will often present with multiple, significant injuries plus acute comorbidities directly impacting your anesthesiologist's decision making. These patients require specific fluid management measures, blood and blood product replacement, and high-skilled airway management. The difficulty of providing correct anesthesia care for such patients is greatly increased. As a result of the additional work needed to administer anesthesia to these patients, CPT added 01173 to describe the procedure.

"Code 01173 is the most specific and is used strictly for three procedures that involve the open treatment of an acetabulum fracture," Lane says. The only three surgical codes that cross to 01173 are the following, she says:

• 27226 -- Open treatment of posterior or anterior acetabular wall fracture, with internal fixation

• 27227 -- Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the acetabulum, with internal fixation

• 27228 -- Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture and both column fracture with complete articular detachment, or single column or transverse fracture with associated acetabular wall fracture, with internal fixation.

"Just as noteworthy is the fact that those three surgical codes only cross to 01173," Lane says. Unlike many other anesthesia codes, she adds, you do not have to choose between multiple anesthesia codes.

01173: Because codes for pelvic procedures expanded in 2003 and provided you more specific options, you should use 01173 instead of 01120 or 01170 for open repair of a pelvic or column fracture. Reason: Code 01173 describes the procedure more accurately. Continue to report 01120 and 01170 for other bony pelvis cases that don't fall under 01173.

01120 vs. 01170: "The more common dilemma is in appropriately choosing between 01120 and 01170," Lane warns. "These two anesthesia codes have at least four surgical procedures in common." In other words, the following surgical codes cross to multiple anesthesia codes, so you need to choose the code most appropriate to your situation.

Those surgical codes include:

• 11012 -- Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, muscle, and bone

• 11044 -- Debridement; skin, subcutaneous tissue, muscle, and bone

• 20680 -- Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)

• 27217 -- Open treatment of anterior ring fracture and/or dislocation with internal fixation (includes pubic symphysis and/or rami).

Each of these four codes crosswalks to both 01120 and 01170 as well as other anesthesia codes, Lane points out. For you to accurately choose between 01120 and 01170, you must know the specific pelvic bone involved (such as the sacrum, coccyx, ilium, pubis, etc.). Remember that 01120 describes anesthesia for a bony pelvis procedure, but 01170 is more specific, describing anesthesia for "open procedures involving symphysis pubis or sacroiliac joint."

For example: You would appropriately crosswalk debridement of an open fracture of the sacrum/coccyx (11012) to 01120, given its location.

In addition to knowing which pelvic bone is involved, you should know what your anesthesia codes really encompass. Remember that 01120 covers both open and closed procedures. "As coders, many times we look for the description to differentiate" between open and closed, Lane says. "In the case of 01120, it does not." Unfairly ruling 01120 out in favor of 01170 simply because the report specifies "open" could lead to miscoding.

"The thing to watch for when coding anesthesia for pelvic procedures is, is there a fracture?" says Lynn McCormack, CPC, of HCA Physician Services in Las Vegas. "Where is the fracture, does it involve the femur? What area or part of the pelvis is involved? When deciding which anesthesia code to use, the operative report is a 'must-have,' but you can also refer to x-rays, CTs, and any other test available."