Anesthesia Coding Alert

Pay special attention to catheter, PICC changes Updates of interest to anesthesia coders for 2004 include three new anesthesia codes, one revised anesthesia code, and more than 20 new or revised codes related to PICC lines, venipuncture and catheter insertion or repair. CPT 2004 goes into effect on Jan. 1, 2004. Get Specific With Updated One-Lung Ventilation and Pelvic Anesthesia Codes CPT 2004 doesn't include many anesthesia-specific code changes, but the ones that were made are welcome additions that will make your coding job easier.
 
New code 00529 (Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy utilizing one-lung ventilation) ties in with 00528, which CPT 2004 revised to specify that it does not include one-lung ventilation (the new descriptor is Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy not utilizing one-lung ventilation).

"One-lung ventilation is fairly new, and CPT is updating the codes to reflect the added risk involved," says Barbara Johnson, CPC, MPC, coder with Loma Linda University Medical Anesthesiology Group in Loma Linda, Calif. "Most of the mediastinoscopy and diagnostic thoracoscopy we've been seeing are without one-lung ventilation, but that may be partly because it wasn't mentioned since it wasn't billable."
 
Codes for pelvic procedures expand with the addition of 01173 (Anesthesia for open repair of fracture disruption of pelvis or column fracture involving acetabulum). Now you'll use this instead of 01120 (Anesthesia for procedures on bony pelvis) or 01170 (Anesthesia for open procedures involving symphysis pubis or sacroiliac joint) for open repair of pelvic or column fracture and will be describing the procedure more accurately, says Debbie Gulledge, CPC, of Anesthesia Associates of Rockhill in Charlotte, N.C. You'll continue to report 01120 and 01170 for other bony pelvis cases that don't fall under 01173.
 
The final anesthesia addition is 01958 (Anesthesia for external cephalic version procedure). This explains the procedure much better than 01960 (Anesthesia for vaginal delivery only), which was your first option for cephalic version, or 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery [this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor]).
 
Information regarding base units for the new codes was not available when Anesthesia Coding Alert went to press. The ASA and the Federal Register both publish base units for all anesthesia codes, so stay tuned for future articles regarding the release of this information. Check Venipuncture, Post-Op Revisions People often ask if they can code for venipuncture when the anesthesiologist is called to perform a difficult stick. CPT 2004 helps answer this question by expanding the descriptors for two common venipuncture codes.

  36400 (Venipuncture, under age 3 years, necessitating physician's skill, not to be used for routine venipuncture; femoral or jugular vein) [...]