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Question: I’m newer to anesthesia coding and need help with an operating room (OR) case. An 82-year-old Medicare patient with insulin-dependent diabetes, stable coronary artery disease, and stage 3 chronic kidney disease presents through the emergency department (ED) with a displaced left intertrochanteric femur fracture after a fall. The orthopedic surgeon performs open reduction and internal fixation (ORIF) with an intramedullary nail. The anesthesia record shows general anesthesia with endotracheal intubation, continuous personal performance by the anesthesiologist, arterial line placement by the anesthesiologist before induction, and anesthesia time from 07:42 to 09:18. The anesthesiologist documents “ASA III” and states the case was emergent because delay would increase the risk of limb-threatening complications. How should I code this?

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Answer: For anesthesia cases, anchor the code to the final operative site and approach; then, verify anesthesia time, provider role, physical status, qualifying circumstances, and separately documented invasive monitoring.

Report 01230 (Anesthesia for open procedures involving upper two-thirds of femur; not otherwise specified) for the anesthesia service because the anesthesia coding is based on the surgical site and procedure performed; in this case, an open procedure involving the proximal femur. Although you won’t report the surgeon’s ORIF code, know that ORIF of an intertrochanteric femur fracture with intramedullary fixation supports anesthesia code 01230.

Report 96 minutes of anesthesia time, from 07:42 to 09:18. If the payer uses 15-minute time units, this equals 6.4 time units before payer-specific rounding. Append modifier AA (Anesthesia services performed personally by anesthesiologist) to 01230 because the anesthesiologist personally performed the case, and append modifier P3 (A patient with severe systemic disease) if the payer accepts American Society of Anesthesiologists (ASA) physical status modifiers.

Report 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous) for the arterial line because the anesthesiologist personally placed it and documented it separately from routine monitoring. The separately documented arterial line supports 36620, assuming payer policy allows separate payment.

Consider reporting 99140 (Anesthesia complicated by emergency conditions), in acknowledgement of the record stating that delaying treatment would increase the risk of limb-threatening complications, if it’s recognized by the payer and supported by documentation of emergency conditions.

Depending on payer policy, qualifying circumstance code 99100 (Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)) may also be applicable.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC