Anesthesia Coding Alert

Question: For the case below, what is the appropriate anesthesia procedure code and modifiers for Dr. Hughes, and what is the correct diagnosis code?

Anesthesiologist: Dr. Hughes

Resident: Aidan H.

Anesthesia: General

Pre-operative diagnosis: Right inguinal hernia

Pre-operative procedure: Laparoscopic hernia repair

ASA: 3

This patient is 74 years old and has traditional Medicare. The post-operative diagnosis indicates the inguinal hernia was obstructed and was not specified as recurrent, and there is no indication of gangrene. Dr. Hughes was not present for the entire case as he is a teaching anesthesiologist with two concurrent cases with a resident in each case. Dr. Hughes’s documentation supports he was present for induction and emergence, present for all key portions, and checked on the resident throughout this case. Documentation supports pre- and post-anesthesia and includes a signed teaching attestation.

South Carolina Subscriber

Answer: For the anesthesia procedure code, you’d report 00840 (Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified). If you missed the extra value for the laparoscopic hernia repair, note that hernia repairs in the lower abdomen are reported under 00830 (Anesthesia for hernia repairs in lower abdomen; not otherwise specified). This code indicates “not otherwise specified,” which refers to procedures that are not specified by any other anesthesia code. Code 00830 would not be correct, given it does not include laparoscopy, and there is a code that does.

In this case, there was a teaching anesthesiologist and a resident, so you would append two modifiers to the anesthesia procedure code: Modifier AA (Anesthesia services performed personally by anesthesiologist) for the teaching anesthesiologist and modifier GC (This service has been performed in part by a resident under the direction of a teaching physician) for the resident. Medicare allows two concurrent cases involving residents to both be reported with a personally performing modifier. The documentation in the patient’s medical record must indicate the teaching anesthesiologist was present during all critical or key anesthesia services and procedures.

If you reported a modifier P3 (A patient with severe systemic disease), it is not incorrect. Although P3 is usually a payment modifier, Medicare does not recognize physical status or qualifying circumstances for additional payment, and these codes are often not included on Medicare claims.

Diagnosis roundup: There is a specific ICD-10-CM code that captures all the pertinent diagnostic information that you should use, K40.30 (Unilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent).