Anesthesia Coding Alert

When your anesthesiologist uses active warming to prevent hypothermia in a patient after surgery, you should already be familiar with codes such as 4250F (Active warming used intraoperatively for the purpose of maintaining normothermia, OR at least 1 body temperature equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time [CRIT]). If your practice is participating in PQRI, knowing how to report the perioperative temperature warming management codes could net you a bonus.

Watch out: If your anesthesiologist participates in PQRI starting in July and reports on measure 193, he will also need to report on measure 76 if he sees more than eight Medicare patients during the six-month period who have a condition that apply to measure 76.

Unplanned perioperative hypothermia occurs when a patient's core body temperature falls below 36 degrees Celsius. Medicare developed measure 193 to encourage prevention of this condition. "The temperature monitoring measure pertains to all patients undergoing anesthesia, other than monitored anesthesia care (MAC), nerve blocks,and cardiac bypass, for 60 minutes or longer," says Scott Groudine, MD, professor of anesthesiology at Albany Medical Center in New York. "Since CMS requires you to report the actual anesthesia time in minutes rather than units this would be an easy measure with which to gauge your 80 percent compliance goal?" Groudine adds.

Reminder: Don't expect immediate reimbursement for the PQRI criteria met by your practice. "Measure 193 is not reimbursed in the traditional sense of the word," says Dawn Shanahan, CPC, supervisor of coding with FGTBA in Tampa, Fla. Like all PQRI measures, if you qualify, a bonus will be sent at the end of the reporting time, which is typically the fall of the following year.

To successfully meet 193, you may need to report more than one PQRI measure code, depending on the length of the surgery. You'll need to follow two steps for measure 193 success. First, you need to determine the length of surgery and report one of these PQRI codes:

If surgery is less than one hour (4 units of time), you will need to only report 4256F (Duration of general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record). You do not need to go to Step 2.

If the surgery meets the time criteria for an hour or longer, report 4255F and proceed to step 2 to also report the second performance measure code.

Next, you need to determine if services meet the performance measure criteria and report one of the corresponding PQRI codes. Here's how: If the measure criteria were met (i.e., the patient was either actively warmed intraoperatively or had a documented temp above 36C within the 45 minute time frame of 30 minutes before the end of anesthesia to 15 minutes after anesthesia end time) you would also report 4250F (Active warming used intraoperatively for the purpose of maintaining normothermia, OR at least 1 body temperature equal to or greater than 36 degrees Centigrade [or 96.8 degrees Fahrenheit] recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time).

If the measure criteria were not performed due to a medical reason -- in other words, temperature management was not indicated due to anesthetic technique, (i.e., MAC or peripheral nerve block, or your anesthesiologist used intentional hypothermia, such as coronary artery bypass surgery) -- report the 4250F code but append modifier 1P (Medical reasons).

If the measure criteria were not performed and there were no medical reasons preventing performance of the measure, then you would need to report 4250F and append modifier 8P (Reasons not otherwise specified).

Example: A patient undergoes surgery for a colon resection that takes two hours. Because surgery is greater than an hour and the patient is under general anesthesia, you will report 4255F.

Pointer: If documentation shows that the patient was treated with a forced air warmer or resistive heating blankets, you can report 4250F regardless of the patient's temperature, Groudine says. If active warming was not used, but the patient's temperature was documented as above 36 degrees Celsius during the 30 minutes before the end of anesthesia to the 15 minutes after, then the anesthesiologist could still report the 4250F code.

If forced air active warming was not used and the patient's documented temperature was not at the measures' goal within the 45-minute window, however, then you would report 4250F-8P.