Anesthesia Coding Alert

Most anesthesiologists and CRNAs prepare for surgical cases knowing exactly what type of service is planned for the patient. The anesthesia coder also knows what procedure has been scheduled and what code should be applied. But what happens when the surgeon actually performs a service thats different from what was anticipated?

This situation occurs more often than not, says
Barbara Johnson, CPC, MPC, of Loma Linda University Anesthesiology Medical Group in California. The patient may be scheduled to have one procedure, she says, but the surgeon realizes that something a little different should be done instead. It may not be a big change, and the anesthesia provider may not even realize that the procedure has been modified. Chances are it doesnt make a difference to the anesthesia provided during the surgery, but it can make a huge difference when its time to code it for reimbursement.

Surgery Code is Key to Getting Paid

Thats because some insurance carriers wont accept an anesthesia code alone for the surgerythey want the CPT code for the actual surgery instead. The situation becomes more complicated when the procedure is altered slightly and requires a different code than the anesthesiology office anticipated. This can happen, for example, when an exploratory laparotomy (49000, exploratory laparotomy, exploratory celiotomy) becomes a colon or small bowel resection (56348, intestinal resection, with anastomosis), or when an ovarian cystectomy (58925) becomes an oophorectomy ( CPT 58940 , oophorectomy, partial or total, unilateral or bilateral).

The key is to be sure the anesthesiology code matches the surgeons code when the paperwork is submitted, Johnson says. That can be hard to do partly because of a lack of communication between the anesthesia and surgery coders and a lack of communication between the surgeons and anesthesia providers as well.

Tips for Matching Codes

So whats a coder to do? Johnson and Tami Maxey, office manager of Independent Billing Agency in Poplar Bluff, MO, a billing agency for anesthesiology, respiratory therapy and medical practices, offer these tips for ensuring that the anesthesia and surgical codes for reimbursement match:

1. Develop a system for seeing or receiving the operative reports so youll have the most recent information on the case before you file the claim. For example, if the anesthesia team routinely works at one hospital, get to know key people in the OR or Medical Records departments who can help you get copies of the reports. Keep track of surgical cases on your own calendar and post reminders to yourself to follow up on cases.

2. Work from [...]