Anesthesia Coding Alert

Anesthesia providers sometimes provide one-lung ventilation for procedures when the surgeon needs a quiet field to operate on, as with lung resection, thoracic aortic repair and some thoracic vertebrae or gastric surgeries. Although an ASA code exists for one-lung ventilation, the new code is not in CPT, so providers are finding that reimbursement is difficult to obtain.
 
The ASA code for one-lung ventilation is 00541 (Anesthesia for intrathoracic procedures, excluding procedures on the heart, great vessels, trachea; utilizing one lung ventilation) and has 15 base units (BUs). If the patient's carrier only accepts CPT codes, use 00540 (Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum [including surgical thoracoscopy]; not otherwise specified). This code makes no assumption about how the lungs are ventilated during the procedure. Because the anesthesia work involved for ventilating one lung is greater than that of standard ventilation, the ASA relative value guide awards that additional work with a higher BU 00541 has 15 BUs compared to 13 units for 00540.
 
"Any thoracotomy procedure could involve one-lung ventilation, but lung resection (32520-32525, Resection of lung; with resection of chest wall; with reconstruction of chest wall, without prosthesis; with major reconstruction of chest wall, with prosthesis) is the most common," says Samantha Mullins, CPC, an anesthesia coder with University of Alabama HSF-MSO specialty coding in Birmingham.
Getting Paid for the New Code
Four options exist to obtain ethical reimbursement for anesthesia for one-lung ventilation based on the carrier:
1. Code the procedure with 00540 for carriers that will not accept 00541, and append modifier -23 (Unusual anesthesia) to signify that something is different about this case. "Modifier -23 can be used to notify the carrier of unusual anesthesia for any procedure with unusual circumstances, for procedures that do not have a specific CPT anesthesia code associated with them, or for procedures with codes that the carrier will not accept," Mullins says. But some carriers will only allow modifier -23 if the procedure is performed under general anesthesia.
2. Bill 00540 with modifier -22 (Unusual procedural services) appended to indicate that the service provided was greater than what is normally required.
 
3. Refrain from coding for the one-lung ventilation until CPT accepts it and report the associated procedures instead. "One-lung anesthesia for thoracotomies is more time-consuming and work-intensive than other types of chest surgery that don't require this special type of ventilation. Because all our insurers pay according to CPT 2002, we cannot use 00541," says Scott Groudine, MD, an Albany, N.Y., anesthesiologist. "Therefore, we can't code for this type of ventilation. A double lumen tube or other device that [...]