Anesthesia Coding Alert

 Follow these 5 steps on difficult procedures The Anesthesia Crosswalk helps you determine the correct anesthesia code for a procedure, but how do you choose between multiple appropriate options? Follow these steps to avoid being tripped up by choices. 1. Start With the Correct Procedure Code  Your first step when coding any anesthesia service is to track down the correct CPT surgical code for the procedure. Base this code on medical record documentation (anesthesia records, op notes and other medical records).
 
If the surgeon performs multiple procedures during the session, select a CPT procedure code for each. “Although you typically only bill one anesthesia code, starting by coding all procedures performed in the session gives you all possible code selections to choose from,” says Samantha Mullins, CPC, MCS-P, ACS-AN, manager of coding and compliance with VitalMed in Birmingham, Ala.
 
2. Go to the Crosswalk The Anesthesia Crosswalk, published annually by the American Society of Anesthesiologists, is one of your most important coding tools. In it, you’ll find every current CPT surgical code and the related anesthesia code(s). Although using the Crosswalk to determine your code sounds simple, your choices aren’t always cut-and-dry.
 
Look up each of the procedure’s surgical codes you selected earlier to identify the default anesthesia codes . If the same anesthesia code keeps popping up, that’s often a good sign that it’s the correct code for you to report, says Barbara Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif.
 
Some procedures only list one anesthesia code, but others …quot; especially procedures that have a variety of anatomical options or management options …quot; can have multiple anesthesia code choices.
 
Example: The surgeon performs lesion excisions in many locations, so the Crosswalk lists many potential anesthesia codes for the procedure. Check documentation such as the excision location to determine the best-fitting anesthesia code. 
 
Pay special attention to documentation for cases that usually have multiple anesthesia code choices, such as:

• Abdominal procedures (upper versus lower abdomen)
 
• Arteriovenous (AV) grafts and fistulas

• Neck dissections (radical, modified radical, etc.)
 
• Heart cases (use of pump oxygenator, hypothermic circulatory arrest, or separately reimbursable services such as transesophageal echocardiography [TEE], Swan-Ganz or central venous line placement or Doppler studies)
 
• Thoracoscopies (use of one-lung ventilation)

• Procedures on extremities (upper arm versus forearm). 3. Follow Codes to the RVG Use the ASA’s Relative Value Guide (RVG) to confirm that your Crosswalk code selection is [...]