Anesthesia Coding Alert

Did you conquer the coding conundrums of 2008? Find out now.

As you wrap up that last superbill of 2008, take a few minutes to see how well you've retained some knowledge about these five tough or quirky coding elements from past issues of Anesthesiology and Pain Management Coding Alert. Grab your coding manuals and a pencil to get started!

Question 1: Your pain management specialist inserts a catheter for a continuous femoral block for acute postoperative pain management for a patient on long-term opioid medications who had an open reduction internal fixation (ORIF) for a distal femur fracture (such as 27506-27507 or 27511-27514). Your physician informs you that he did post-op "rounds" on the patient for two days to monitor the continuous infusion. The pain management catheter insertion procedure is separately billable.

TRUE FALSE

Hint: Newsletter Vol. 10, No. 5, might help you out.

Question 2: Your anesthesiologist provides services for a balloon valvuloplasty (92986, Percutaneous balloon valvuloplasty; aortic valve) to treat stenosis. Your physician's notes mention that rheumatic fever developed after the patient had a Streptococcus infection that went untreated. You should choose ICD-9 code:

a) 395.0 -- Rheumatic aortic stenosis

b) 395.2 -- Rheumatic aortic stenosis with insufficiency

Hint: Check out Vol. 10, No. 8, for a clue.

Question 3: Your anesthesiologist performs routine hypothermia for coronary artery bypass graft (CABG). You should report +99116 (Anesthesia complicated by utilization of total body hypothermia [List separately in addition to code for primary anesthesia procedure]) with the anesthesia code.

TRUE FALSE

Hint: Warm up to Vol. 10, No. 9, for more information.

Question 4: A surgeon discontinues a procedure after anesthesia. You should use modifier 74 (Discontinued outpatient ... procedure after anesthesia administration) with the anesthesia code for the anesthesiologist's service.

TRUE FALSE

Hint: Look up Vol. 10, No. 11, for help.

Question 5: A single level for a paravertebral facet joint injection deals with the interspace -- or "joint"-- between two vertebrae. Therefore, one level of block will involve an injection into the joint itself, or two injections blocking each of the paravertebral facet joint (medial branch) nerves that provide sensory information from the joint back to the spine.

TRUE FALSE

Hint: Look at Vol. 10, No. 12, for more help.