Part B Insider (Multispecialty) Coding Alert

Not all thoracotomies are created equal

Anesthesiology coders, don't sleep on opportunities to gain extra reimbursement. Here are some areas where you may not be billing the correct amounts:

• Thoracotomy: Not all thoracotomies are the same, says Scott Groudine, associate professor of anesthesiology with Albany Medical Center in Albany, NY. A typical thoracotomy will have 12 base units, so you'd bill 00540. But if the physician  uses one lung ventilation, then you have 15 base units and thus bill 00541.

The same goes for a diagnostic thorascopy and mediastinoscopy: You'll usually have eight units and bill 00528 , but if the physician uses one lung ventilation, you have 11 units and bill 00529.

"One lung ventilation is more work intensive, has a higher risk associated with it and usually requires the insertion of a double lumen tube, or a bronhial blocker," explains Groudine. If you pay attention to this added work, you can boost your reimbursement by three extra units.

• Laparoscopic surgery: Some-times the procedure that takes the longest isn't the one you should bill for, says Groudine.

Case in point: A surgeon spends hours on a laparoscopic bowel surgery, such as a sigmoid colectomy, and then at the end of the procedure removes the patient's gall bladder. Even though the majority of the surgeon's time was spent on the bowel surgery, the gall bladder removal (00790) has more base units than lower-abdomen anesthesia (00840), seven units instead of six.

Unlike surgeons, anesthesiologists don't get paid more for additional procedures, so you have to make sure you bill for the procedure that has the highest base rate, Groudine points out.

• Emergency modifiers. Some carriers may allow anesthesiologists to use 99140, the so-called "emergency modifier" that adds two   base units to your reimbursement, notes Groudine. You should check on your carrier's policy. Many coders don't realize they can bill this modifier, and they lose out  on extra reimbursement they're  entitled to.