Anesthesia Coding Alert

Hint: Verify if it's routine hypothermia or circulatory arrest Anesthesiologists routinely lower patients' body temperatures to hypothermic levels during cerebral vascular procedures, pediatric cardiac repairs, or other complicated surgeries. But when an anesthesiologist takes this one step further and lowers patients' body temperatures to hypothermic circulatory arrest during complex surgeries - such as intracranial vascular surgery - does your coding freeze up?
 
If so, use these expert guidelines for differentiating between routine and deep hypothermia to avoid getting cold feet when coding for hypothermia. Differentiate Between Hypothermia Types "Hypothermia" is the general term for allowing the patient's body temperature to fall modestly. The patient's heart is still beating, or the anesthesiologist uses a pump oxygenator to control blood circulation. "Hypothermic circulatory arrest," however, is the term for when the anesthesiologist lowers the patient's body temperature to the extent of zero cardiac output - no heartbeat and no pump oxygenator.
 
Keep these points in mind when you're distinguishing between routine hypothermia or hypothermic circulatory arrest:
 
Routine hypothermia:

commonly goes with procedures such as CABG, traumatic brain injury, cerebral aneurysm, or other neurological problems
involves purposely reducing the patient's temperature, but not to the degree of hypothermic circulatory arrest. Hypothermic circulatory arrest:

is also called deep hypothermic circulatory arrest (DHCA) or profound hypothermia
is used when surgery requires a motionless field
is a way to protect the brain from ischemia that could result from no cardiac output during aortic surgery or brain or heart surgery (especially in infants)
involves halting blood circulation under low-temperature conditions. Arm Yourself With the Correct Codes CPT includes several codes for anesthesia during cardiac or CABG procedures, but they don't all apply to hypothermia cases. Your two options are:

00562 - Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator
00563- Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator with hypothermic circulatory arrest. Whether you usually report 00562 or 00563 will depend on the physician group and types of cases they handle. "We see more cases using circulatory arrest for cardiac and intracranial procedures," says Julee Shiley, CPC, CCS-P, CMC, an anesthesia coding consultant in Columbia, S.C.

If the anesthesiologist participates in a standard CABG case using routine hypothermia, report 00562, says Barbara M. Johnson, CPC, MPC, president of the consulting firm Real Code Inc., in Moreno Valley, Calif. Code 00563 comes into play when the physician induces circulatory arrest.
 
Pitfall: Cardiac codes 00560 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator) and 00566 (Anesthesia for direct coronary artery bypass grafting without pump oxygenator) don't apply to hypothermia cases.
 
In hypothermia cases, the anesthesiologist uses a pump oxygenator to achieve deliberate [...]