Anesthesia Coding Alert

Question: What are the correct anesthesia and surgical codes, modifiers, and diagnosis codes to report for the following case? Also, is it necessary to deduct the time for the TAP block from the total anesthesia time reported?

A 68-year-old male patient undergoes a laparoscopic cholecystectomy for acute on chronic cholecystitis. Dr. Taylor personally provides general anesthesia from 11:21 a.m. to 13:29, with a documented break from 12:02 to 12:32. While Dr. Taylor is on break, Dr. Swift documents a transfer of care and enters an electronic note that the surgeon ordered a bilateral transversus abdominis plane (TAP) block for postoperative pain management. Dr. Swift performed the bilateral TAP block using imaging guidance from 12:11 to 12:17. Dr. Taylor documented transfer of care from Dr. Swift at 12:32 and stayed with the patient through the end of the case.

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Answer: CPT^® code 47562 (Laparoscopy, surgical; cholecystectomy) crosswalks to ASA code 00790 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified).

ASA code: In this case, the appropriate anesthesia code to report for Dr. Taylor’s services is 00790 with modifier AA (Anesthesia services performed personally by anesthesiologist) appended. Note that the documented transfer of care for a lunch break doesn’t require changing the reporting physician.

Diagnosis roundup 1: For the surgical procedure, the provider indicates and reports acute and chronic cholecystitis, coded with K81.2 (Acute cholecystitis with chronic cholecystitis). Double-check the claim for Dr. Taylor to ensure the diagnosis associated with 00790 matches the surgical diagnosis.

TAP block CPT^® code: For the post-op bilateral TAP block, use 64488 (Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)) and append modifier XP (Separate practitioner …) to indicate that another anesthesiologist (Dr. Swift) provided this separate service. If the payer doesn’t accept X{EPSU} modifiers, then apply -59 (Distinct procedural service).

“Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used,” according to Medicare Learning Network Fact Sheet MLN1783722 (www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xe-xp-xs-and-xu.pdf ).

Diagnosis roundup 2: The reason for the TAP block is to manage postoperative pain not otherwise specified (NOS), for which you’d use G89.18 (Other acute postprocedural pain). Make sure to use this diagnosis and associate it with 64488 on the claim form for Dr. Swift.

Lastly, you do not need to deduct the block time. According to the American Society of Anesthesiologists (ASA), “Time for a post-operative pain procedure that occurs after induction and prior to emergence does not need to be deducted from reported anesthesia time” (www.asahq.org/standards-and-practice-parameters/statement-on-reporting-postoperative-pain-procedures-in-conjunction-with-anesthesia).