Anesthesia Coding Alert

Question: What are the correct surgical and anesthesia codes, modifiers, and diagnosis codes to report for the following case? Also, should this case be reported to Medicare or Cigna?

Anesthesiologist: Dr. Gray and CRNA

Anesthesia: General; ASA III

Postop diagnosis: Malignant neoplasm of internal urethral orifice

Procedures: Cystourethroscopy, resection of small bladder neck tumor, 1.9 cm per op report.

This patient is 67 years old and has a Medicare policy. He is still working and has employer coverage with Cigna. Dr. Gray medically directed this case concurrent to one other Medicare case.

AAPC Forum Participant

Answer: In this case, you should file the claim with Cigna — working elderly with insurance coverage from their employer are Medicare Secondary Payer (MSP) patients.

Diagnosis: Use C67.5 (Malignant neoplasm of bladder neck) to report the bladder cancer.

Surgery code: In order to determine the correct CPT^® code for cystourethroscopy and neoplasm resection, you have to know the size of the bladder tumor. Since this patient had a 1.9 cm mass, you should report 52234 (Cystourethroscopy, with fulguration … and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)). Although the anesthesia code is the same, the surgical code will vary based on bladder tumor size.

ASA code: When you crosswalk the surgical code, you’ll find the appropriate anesthesia code is 00912 (Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of bladder tumor(s)). Even though one of the two concurrent cases is a commercial policy, Medicare still requires each of the cases to be counted in the concurrency report. So for Dr. Gray, you’ll submit 00912 with -QK (Medical direction of two, three, or four concurrent anesthesia procedures …); not -QY (… one certified registered nurse anesthetist (crna) by an anesthesiologist). Then, add modifier P3 (A patient with severe systemic disease) after the payment modifier for one additional unit.

Keep in mind: Cigna, the primary payer, will allow additional payment for P3; however, if Medicare was the primary payer, P3 would not be paid separately.

For the certified registered nurse anesthetist (CRNA) report 00912 with modifiers QX (Crna service: with medical direction by a physician) and P3 appended.