Distinguish Anesthesia Timing for These Two Concurrent Procedures
Question: An anesthesiologist participated in a breast reconstruction procedure after a patient underwent a prior mastectomy due to breast cancer. The procedure also encompassed liposuction to the abdomen and thighs. Anesthesia times were 7:30 a.m. to 9:55 a.m. for the breast reconstruction and 9:56 a.m. to 10:45 a.m. How do I code a situation like this, where part of a procedure is covered by the payer and part (the liposuction) is an elective cosmetic procedure? Codify Subscriber Answer: For billing purposes, this is treated as two separate procedures but typically documented in the same anesthesia record. The first step is to determine which portion of the case is covered by the payer and which portion is considered cosmetic, and therefore patient responsibility. Accurate documentation is important and the anesthesia record should clearly identify the start and stop times for each portion of the case, which portion is covered by insurance, and which portion is cosmetic. Insurance claim: The breast reconstruction is covered by the payer, so report 00402 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; reconstructive procedures on breast (eg, reduction or augmentation mammoplasty, muscle flaps)) with 145 anesthesia minutes for this procedure. Cosmetic claim: The liposuction is the cosmetic/self-pay portion of the case, and you should code 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) with 49 anesthesia minutes for this procedure. Typically, the cosmetic portion is paid by the patient prior to the procedure. The payment will be based on a cosmetic fee schedule established by the anesthesia group. Julie McDaniel, MHA, CPC, CANPC, Contributing Writer
