Anesthesia Coding Alert

Here's how to reduce denials -- and also increase your pay Patients often request anesthesia anytime they anticipate pain during a procedure, but that doesn't mean the insurance carrier will pay for it. You can help justify anesthesia for some patients -- regardless of which procedure the surgeon performs -- by reporting the appropriate "V" codes. Give the Full Picture With V Codes The facts: The ICD-9 manual lists V codes under the category heading "Supplementary Classification of Factors Influencing Health Status and Contact with Health Services." This means that V codes often describe chronic conditions or underlying circumstances that might affect a patient's current health status or treatment.

How does this help you? Sometimes the V code will provide just enough information to turn a denial into appropriate -- or even extra -- reimbursement.

Your patient might have an underlying condition that upgrades him to general anesthesia instead of IV sedation or a local anesthetic, says Terry Garcia of Tejas Anesthesia in San Antonio. She sees this with patients whose conditions influence their health status (categories V40-V49). These V codes can help justify reporting a higher physical status modifier (P1-P6) for the patient and medical necessity for anesthesia -- both of which may lead to higher reimbursement.

Don't miss: In some cases, carriers require specific V codes before reimbursing you. For example, a New York policy lists only two diagnoses justifying post-operative epidurals: 958.8 (Other early complications of trauma) for patients being treated for major trauma but  not requiring surgery, and V58.49 (Other specified aftercare following surgery) for patients being treated for postoperative pain management. Consider Reporting a V Code as Primary Diagnosis Most coders relegate V codes to secondary diagnoses, but you can sometimes report a V code as your primary diagnosis. If ICD-9 designates a code as "SDx," you must report it as a secondary diagnosis. But if ICD-9 prints the symbol "PDx" next to a code, you can use it as your primary diagnosis. You can report codes without a designation as primary or secondary.

Example: "We've used the V10.x codes (Personal history of malignant neoplasm) as a primary diagnosis when coding for tests such as a colonoscopy or endoscopy," says Donna Howe, CPC, office manager of Anesthesia Associates of Eastern Connecticut in Manchester. She also recommends codes in the V16.x list (Family history of malignant neoplasm) if the patient has a family history and the referring physician wants to conduct regular testing as a preventive measure.

Other V codes that Howe and Garcia often use for primary diagnoses include V54.01 (Encounter for removal of internal fixation device) for orthopedic hardware removal, V59.4 (Donors; kidney) for donor nephrectomies, and V59.9 (Donors; unspecified organ or tissue) for organ harvesting. Code [...]