Anesthesia Coding Alert

Check your base units to avoid audit troubles

Even if upcoding claims (miscoding procedures and bringing your group higher reimbursement than appropriate) is an honest mistake, your group can pay the price if the same errors keep cropping up.

Zero in on these three coding areas to help keep your claims on track and your bottom line honest: 

• Reporting a higher base for a procedure that's not accurate
• Failing to use unlisted-procedure codes
• Coding incorrectly because of insufficient documentation. Double-Check Your Base Units' Accuracy The American Society of Anesthesiologists and other groups offer resources to help you report each procedure's base units, but incorrect amounts still find their way to carriers. Having someone on staff who is certified or well-versed in coding to oversee the process can help you steer clear of such basic errors, says Jann Lienhard, CPC, an anesthesia coding consultant in Marlton, N.J.

Why it matters: Anesthesia providers multiply a dollar amount by each procedure's base units to determine part of their reimbursement. Procedures with higher base units lead to higher reimbursement. Working higher base units into your reimbursement equation looks good on your bottom line but doesn't hold water when an auditor discovers the mistake.

When you see it: You frequently see misreported units for intracranial procedures, back or spinal procedures and intrathoracic versus closed chest procedures, says Mary Klein, CPC, of Panhandle Anesthesia in Pensacola, Fla. Lienhard adds critical care and E/M services to the list.

Examples: Anesthesiologists often participate in spinal tap procedures. Coders sometimes report 00630 (Anesthesia for procedures in lumbar region; not otherwise specified) with 8 base units, but the more appropriate choice is 00635 (... diagnostic or therapeutic lumbar puncture) with 4 base units.

An even bigger difference in base units shows if you report 00500 (Anesthesia for all procedures on esophagus) with 15 base units for an esophagoscopy with lesion removal, when you should report 00520 (Anesthesia for closed chest procedures; [including bronchoscopy] not otherwise specified) with 6 base units.

How to avoid it: Read code descriptors completely before choosing your anesthesia code, Klein says. Talk with your providers if they write incomplete or inaccurate procedure descriptions in the chart. Lienhard adds that you should keep up-to-date with CPT criteria, especially when coding critical care or E/M services.
 
"CPT is specific on these items, and many providers do not take the time to analyze what they are doing and what they are coding for," she says. "Review the notes yourself instead of simply taking the provider's word for what the codes should be."
 
Don't Shy Away From Unlisted-Procedure Codes    As a coder, your must report each procedure with the most accurate code possible. Resorting to unlisted-procedure codes (such as 01999, Unlisted anesthesia [...]