Anesthesia Coding Alert

Question: What is the appropriate anesthesia procedure code and modifiers for Dr. Jones, and what is the appropriate anesthesia procedure code and modifiers for the CRNA?

Anesthesiologist: Dr. Jones

CRNA: Milton Gage

Anesthesia: General

Diagnosis: Bleeding, post-operative transurethral resection of bladder tumor

Procedure: Fulguration of bladder neck bleeding, post TURBT

ASA: 4

This patient is 56 years old and has UnitedHealthcare (UHC) insurance. Dr. Jones has three concurrent cases, including this case. Their documentation supports they were present for induction and emergence, present for all key portions, and all other steps of medical direction.

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Answer: For the anesthesia procedure code, you’d report 00910 (Anesthesia for transurethral procedures (including urethrocystoscopy); not otherwise specified). You can crosswalk the postoperative bleeding requiring fulguration from CPT^® code 52214 (Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) to anesthesia code 00910.

In this case, there was an anesthesiologist (supervising three concurrent cases) and a certified registered nurse anesthetist (CRNA). For Dr. Jones, you would append two modifiers to the anesthesia procedure code: modifier QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals) and modifier P4 (A patient with severe systemic disease that is a constant threat to life). You’d report 00910 with modifiers QX (Crna service: with medical direction by a physician) and P4 appended for the CRNA.

Take note: UHC indicates they follow medical direction criteria as defined by the Centers for Medicare & Medicaid Services (CMS) in their anesthesia policy. They will also allow two additional units for P4 status. UHC often includes payment for physical status modifiers or other qualifying circumstances in the allowance for the anesthesia procedure, so watch payments carefully.

You might have been tempted to assign 00912 (Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of bladder tumor(s)) but that would be incorrect in this case. Code 00912 was the initial anesthesia code reported when the patient had transurethral resection of bladder tumor (TURBT).

Diagnosis roundup: There is a specific ICD-10 code that captures all the pertinent information about the patient’s condition, N99.820 (Postprocedural hemorrhage of a genitourinary system organ or structure following a genitourinary system procedure).