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. Codes Now Specify Diagnostic Versus Surgical 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 [...]