Anesthesia Coding Alert

Hint:  Pay more attention to companion services than DLT

Coders- opinions differ on whether you can bill separately for a double lumen tube. If you-re on the fence in these situations, consider the following situation and then read what some of our experts recommend.

Scenario: Our anesthesiologist documented general anesthesia and double lumen for a lung biopsy. The chart does not specify if the surgeon used an open approach or thoracoscopy. Should I report general anesthesia for the procedure and add on the double lumen tube? Double-Check the Surgeon's Technique Your first step in handling this claim is to verify the surgeon's technique. CPT has two main coding options for this type of procedure, so determine which is correct before attempting to report the anesthesia:

- 32602--Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, with biopsy. You should base your coding on this if the surgeon used a closed approach. 

- 32095--Thoracotomy, limited, for biopsy of lung or pleura. Work from this code instead if the surgeon used an open approach. Don't just crosswalk: But filing the claim isn't as simple as crosswalking to a single anesthesia code. You also need to look at the anesthesiologist's work to narrow your options. Track Down One-Lung Ventilation Details Inserting a double lumen tube allows the anesthesiologist to use one-lung ventilation (OLV) during the procedure. Although the scenario above doesn't specify whether the anesthesiologist used OLV during the procedure, he probably did--inserting a double lumen tube that's not used for OLV is rare.

The physician receives higher reimbursement when he uses OLV, primarily because of the level of work and risk involved with the case.

If the record shows that the patient was on OLV, you can report one of the higher-unit codes that rewards the additional work involved:

- 00529--Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy utilizing one lung ventilation. This code represents a mediastinoscopy approach to biopsy when the anesthesiologist uses OLV. It's more involved than a standard mediastinoscopy approach but is much less than a thoracotomy. Report 00529 if the surgeon used a closed approach (32602) and the anesthesiologist used OLV.

- 00541-- Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); utilizing one lung ventilation. This code for thoracotomy using OLV is worth quite a bit more than 00529 (15 units versus 11). Report 00541 if the surgeon used an open approach (32095) and the anesthesiologist used OLV. Caution: Do not bill for one-lung ventilation unless the anesthesia record or graph clearly shows that the [...]