Anesthesia Coding Alert

Coding for arthroscopic procedures, which account for as much as 25 percent of some groups'procedures each month, used to be as simple as locating the joint in question and reporting the lone arthroscopy code for that site. But CPT 2003 changed all that by adding more stand-alone and indented codes to the previous five for anesthesia during various arthroscopic procedures, which means you can code these procedures much more accurately.

In many instances, the biggest change with the arthroscopic codes is more detailed descriptors now most include new distinctions between diagnostic and therapeutic/ surgical procedures. Scott Groudine, MD, an Albany, N.Y., anesthesiologist, offers this tip for understanding the difference: Diagnostic procedures (arthroscopic or otherwise) simply look at something, and surgical procedures actually treat the area in some way. Recovery from diagnostic procedures should take less time and be less involved than surgical procedures that changed the patient's anatomy. Codes showing these differences help justify the need for additional recovery time, physical therapy, and pain medications after therapeutic surgery.

For example, the old code for arthroscopic procedures in the shoulder area was 01622 (Anesthesia for arthroscopic procedures of shoulder joint). Now you can choose between two codes for shoulder procedures: 01622 (with a revised descriptor of Anesthesia for diagnostic arthroscopic procedures of shoulder joint) and 01630 (Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified).

In addition to specifying diagnostic versus surgical procedures, code changes also specify whether the surgical procedure was open or arthroscopic. Many anesthesia code revisions include terminology specifying that the code is now for open surgical procedures, then CPT2003 added a new code for arthroscopic procedures in the same area. These often relate to revised or new surgical codes that distinguish between surgical and diagnostic arthroscopy procedures.

For example, new code 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair) complements open procedure code 23412 (Repair of ruptured musculotendinous cuff [e.g., rotator cuff] open; chronic), says Susan West, RHIT, of the consulting firm Auditing for Compliance and Education Inc., in Leawood, Kan. Code 23412 still crosses to anesthesia code 01610 (Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of shoulder and axilla), while 29827 crosses to revised anesthesia code 01630 (which now specifies open or surgical arthroscopic procedures).

Distinguishing between procedure types makes claims more accurate because coders have more options. Knee arthroscopy is just one example of how the diagnostic/ open distinction does this. "In 2002, if the physician documented 'Surgical arthroscopy for lateral meniscus repair,'we were limited to one code whether it was a diagnostic or surgical arthroscopic procedure (01382, old descriptor of Anesthesia for arthroscopic procedures of knee joint, with 3 base units)," says Emma LeGrand, CCS, CPC, office manager with New Jersey Anesthesia Associates in Florham Park. "Now that 01400 (Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified) specifies open or surgical knee arthroscopy, we can code more specifically, and the physician receives a more appropriate reimbursement of 4 base units." (Still use 01382, revised as Anesthesia for diagnostic arthroscopic procedures of knee joint, for the diagnostic procedure.)

Why were so many changes made to distinguish between diagnostic and surgical approaches? LeGrand believes it was to demonstrate the additional work or effort the anesthesiologist provides during open and surgical arthroscopic procedures. She again cites code 01400 as an example. "Now code 01400 includes 'open or surgical arthroscopic procedures'in the descriptor, which allows us to bill 4 base units for surgical arthroscopy of the knee. Until now, surgical arthroscopic procedures of the knee were billed the same as diagnostic arthroscopic procedures, with 3 base units."

Changes and distinctions in codes also help coders keep up with advances in technology and patient care, she adds. And because filing with more detailed codes requires better physician documentation of the procedures, you may search for details in the surgical operative reports more often.

Accurately reporting wrist and hand procedures has been a longstanding challenge because the existing codes didn't cover everything well enough, particularly for arthroscopic procedures. This is one area in particular that LeGrand says the 2003 changes make it easier for coders to comply with coding guidelines and select more definitive procedure codes.

Consider a patient who has open reduction and internal fixation for a distal radius and ulna fracture. Coders previously used 01830 for this despite a very general descriptor (Anesthesia for open procedures on radius, ulna, wrist, or hand bones; not otherwise specified). CPT 2003's revised 01830 code is more descriptive (Anesthesia for open or surgical arthro-scopic/endoscopic procedures on distal radius, distal ulna, wrist, or hand joints; not otherwise specified), so you can code the same procedure more accurately.

The addition of 01829 (Anesthesia for diagnostic arthroscopic procedures on the wrist) clarifies coding by distinguishing diagnostic from surgical wrist procedures. West says that 29840 (Arthroscopy, wrist, diagnostic, with or without synovial biopsy [separate procedure]) used to cross to anesthesia code 01830 but now crosses to 01829, making reporting more accurate.

Regardless of the new and revised code descriptors, don't expect more specific codes always to mean reimbursement changes. "Reimbursement may or may not change, based on the location of the body area and the corresponding ASAcode," West says.

For example, any method of lateral retinacular release in 2002 was reported with 27425; now 27425 (Lateral retinacular release open) specifies open release, and new code 29873 (Arthroscopy, knee, surgical; with lateral release) is used for arthroscopic procedures. The two cross to different anesthesia codes 01320 (Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of knee and/or popliteal area) and 01400 (Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified), respectively but both are 4 base units.

One of the biggest advantages to the new and revised codes is the opportunity to stress thorough documentation to physicians, LeGrand says. "Hopefully, these changes will inspire the physicians to be more specific with their documentation," she says. "Coders must demonstrate to physicians that some of the new codes will have an impact on reimbursement which should give some of them incentive plus help report their services more accurately."