Anesthesia Coding Alert

Question: How should I code for anesthesia during a cystoure­throscopy with lithotripsy for a diagnosis of kidney or ureteral stones?

Louisiana Subscriber

Answer: The ASA Crosswalk lists 00918 (Anesthesia for transurethral procedures [including urethrocystoscopy]; with fragmentation, manipulation and/or removal of ureteral calculus) as the primary anesthesia code for procedures 52352-52355 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy ...) but don't make that your automatic choice. Notes below each code from 52352-52355 state you should report 00862 (Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper one-third of ureter, or donor nephrectomy) when lithotripsy involves the kidney or upper one-third of the ureter. Because of this "upper one-third" distinction, you'll need a copy of the operative report to code accurately.

Many coders gauge their anesthesia code selection by the stones' location. They submit 00910 (Anesthesia for transurethral procedures [including urethrocystoscopy]; not otherwise specified) for a bladder stone, 00918 for a ureter stone, and 00862 for a kidney stone.