Anesthesia: Collect Every Dollar
Common documentation and coding errors undermine anesthesiology reimbursement.
By Pam Linton, CPC
Anesthesia groups must take the appropriate steps to reduce or eliminate common documentation and coding mistakes if they are to collect every dollar to which they are entitled.
Reducing errors requires a detailed, up-to-date understanding of anesthesia coding, a working knowledge of anatomy, and open channels of communication between coders and physicians. A process allowing coders to follow up with physicians on specific case questions while offering real-time feedback regarding incomplete or inaccurate documentation can go a long way toward strengthening the anesthesia revenue cycle.
Understand Procedure Details
Many of the most common under-coding errors affecting anesthesia reimbursement result from a lack of detail and clarity about a surgical procedure’s underlying nature and location. Here are some primary examples:
Anterior Lumbar Interbody Fusion: A regular spinal fusion pays eight base units if located in the lumbar region, but pays 10 base units if located in the cervical region. If the fusion involves instrumentation—such as the installation of a cage, plate, or screws—the anesthesia portion pays 13 base units. Financially speaking, it’s worthwhile to determine and document the exact nature and location of the fusion.
Abdominal Cavity: Location, likewise, is important in surgical procedures involving the abdominal cavity. If the procedure involves the lower abdomen, it is worth six units. If it is in the upper abdomen, it is worth seven units.
Cardiac Bypass Surgery: The key question for coders here is: Was the procedure on-pump or off-pump? If a bypass machine is used during the procedure and the heart is stopped to facilitate bypass installation, the procedure is worth 18 units. If the heart is not stopped, the procedure becomes more complex for both anesthesiologist and surgeon. Off-pump bypass surgery pays 25 units. A coronary artery bypass grafting (CABG) redo occurring more than 30 days from the original surgery pays 20 units.
Interstitial Radioelement Application or Biopsy – Prostate: In my experience with auditing outside anesthesia groups, this procedure is under-coded approximately 80 percent of the time. If the procedure is done without ultrasound, it is worth three base units. But if trans-rectal ultrasound is used, it is worth five base units.
Thoracostomy/Thoracotomy: If one lung is deflated (one-lung ventilation) in the course of a thoracostomy/thoracotomy, the case is worth either 11 or 15 base units. That compares to eight or 12 base units if one lung is not deflated. Some of the minor thoracostomy procedures have either eight base units (when one-lung ventilation is not used) compared to 11 (when one-lung ventilation is used). The thoracotomy and some extensive thoracostomy procedures have either 12 base units (when one-lung ventilation is not used) compared to 15 (when one-lung ventilation is used).
Epigastric Hernia Repair: The key here is whether the hernia is strangulated and involves the intestines. If so, the procedure is worth seven base units. If not, the rate is four base units.
Hysterectomy: In the case of radical hysterectomies, wherein lymph nodes may be removed and additional biopsies performed, anesthesiologists are entitled to eight base units. That compares to six base units for a standard, abdominal hysterectomy.
Kidney Stone: Specific anatomical location can also be a key factor in determining how many units the case is worth. If the kidney stone is actually in the kidney, or in the upper one-third of the ureter, payment is seven base units. If the stone is located further down in the ureter, it pays five base units.
Hip Replacement and Revision: A total hip replacement pays eight base units. If the patient has had a prior replacement, however, and the procedure is a revision, anesthesiologists receive 10 base units.
Shoulder Arthroscopy: A simple diagnostic shoulder scope pays four base units. It is rare, however, that a diagnostic scope is not done with surgical repair or debridement. If surgery is performed, the scope is worth five units. It’s important to determine whether the scope was performed with surgery.
Knee Arthroscopy: If diagnostic-only, the scope pays three base units. If done with surgery, the scope pays four base units. Although diagnostic-only knee scopes are more common than diagnostic-only shoulder scopes, they remain a common area of under-documentation.
Education is Key
Year after year, anesthesiology groups leave significant dollars on the table as a result of under-coding errors. In today’s difficult economic environment, such errors are no longer acceptable. That is why continuing education is vital. A comprehensive education program can help to ensure coders clearly understand the nuances, codes, and reimbursement levels associated with a wide range of specific surgical procedures.
Physicians likewise should be provided with ongoing education to make sure they are documenting as accurately and completely as possible. Periodic internal audits can provide insight into where the most significant problems lie, and help focus educational efforts for both coders and physicians.
Anesthesia practices should establish a robust system for real-time interaction between coders and physicians to address issues or questions that arise regarding specific procedures. This process strengthens reimbursement both by reducing under-coding and by limiting potential denials before the claim is filed.