Anesthesia Coding Alert

Things don't always turn out the way the anesthesiologist (or the surgeon) plans and when surgeons are forced to perform surgical procedures they weren't expecting, anesthesia coders need to be able to think on their feet.

When surgical procedures change on the fly, anesthesia coders must answer two questions: First, does the new surgical code merit a new anesthesia code for accurate billing? And second, how important is it to have the absolutely correct CPT procedure code if the corresponding anesthesia code stays the same? Anesthesia Codes Are More General Than Surgicals Surgical CPT codes, by nature, are very specific about the procedures they report. A primary procedure code may have multiple subcodes related to it; each code varies slightly from the others in the group so that exact services can be reported. But since the anesthesia used for this group of similar procedures will usually remain the same, the surgical codes often cross to the same anesthesia code. For example, CPT lists 12 codes related to cataract removal, ranging from 66830 (Removal of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid] with corneo-scleral section, with or without iridectomy [iridocapsu-lotomy, iridocapsulectomy]) to 66986 (Exchange of intraocular lens). Each code describes a particular technique or approach to the surgery, but they all cross to anesthesia code 00142 (Anesthesia for procedures on eye; lens surgery).

"The point is that the CPT surgical codes are much more descriptive of procedures, whereas the anesthesia codes are more general," says Emma LeGrand, CCS, CPC, office manager for the physician group New Jersey Anesthesia Associates PC, in Florham Park, N.J. "That's good, because surgical codes need to be more specific so procedures can be reported as accurately as possible. But since anesthesia administration is often the same for similar procedures, the anesthesia codes are broader and apply to more situations." Is It Ever OK to Change the Code? Sometimes the original procedure's code remains in the patient's anesthesia record, even if the services performed are different. What should you do when coding for the case if you notice that the operative notes describe a procedure other than the one originally anticipated? For example, a patient may be scheduled for a cystourethroscopy (52000, Cystourethroscopy [separate procedure]), but the patient's record reflects a cystourethroscopy with biopsy (52204). Both surgical codes crosswalk to anesthesia code 00910 (Anesthesia for transurethral procedures [including urethrocystoscopy]; not otherwise specified), so the anesthesiologist will be reimbursed correctly either way.

Because a growing number of carriers are more interested in the anesthesia codes than the corresponding surgical codes, some coders tend to let these types of slight inaccuracies slide. But others strive [...]