Anesthesia Coding Alert

Question: A 4-year-old child with recurrent otitis media undergoes bilateral myringotomy with tympanostomy tube placement. The anesthesia provider documents the child as being ASA 1, and the anesthesiologist personally performs general anesthesia. Which anesthesia code and modifiers should I report?

Delaware Subscriber

Answer: Considering the information provided, you can report 00126 (Anesthesia for procedures on external, middle, and inner ear including biopsy; tympanotomy) for the anesthesia service. Code 00126 describes anesthesia for procedures involving tympanotomy and is appropriate for myringotomy with tympanostomy tube insertion. The anesthesia code is selected according to the operative site and procedure rather than just the patient’s age or the type of anesthetic administered.

You also mentioned that the patient is ASA 1, which is a physical status classification used by the American Society of Anesthesiologists (ASA). Append modifier AA (Anesthesia services  performed personally by the anesthesiologist) because the anesthesiologist personally performed the anesthesia and modifier P1 (A normal healthy patient) because the anesthesiologist documents that the patient is ASA 1, in terms of physical status. Your claim should read 00126-AA-P1.

Make sure you’re reporting the documented anesthesia time according to the payer’s billing requirements. For example, Medicare does not add payment units for physical status modifiers.

For the most comprehensive and accurate coding, you’ll need to verify the operative procedure, anesthesia start and stop times, physical status, and provider arrangement before submitting the claim. Payer rules may differ regarding modifier order and whether physical status modifiers affect payment.

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