Anesthesia Coding Alert

Though most anesthesiologists routinely lower a patient's body temperature to hypothermia levels during coronary artery bypass graft (CABG) surgery, getting proper reimbursement from payers is anything but routine. When a physician brings a temperature to hypothermia levels, some of the "qualifying circumstances for anesthesia" codes from the back of CPT can come into play, along with the appropriate anesthesia codes. How should you use these codes to get appropriate reimbursement from different carriers? Our experts provide some tips: Know All the Coding Possibilities Two anesthesia codes related to performing CABG with the pump oxygenator can apply to these situations, depending on case specifics and the carrier:

CPT 00562 Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator (used for standard CABG cases)
cpt 00563 ... with pump oxygenator with hypothermic circulatory arrest (used for patients with cardiac arrest) The third code related to CABG, 00560 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator), does not apply to these cases because the physician already needs the oxygenator to achieve deliberate hypothermia and will also need it to normalize the patient's body temperature. Qualifying-circumstances code +99116 (Anesthesia complicated by utilization of total body hypothermia [list separately in addition to code for primary anesthesia procedure]) is the additional code that some carriers will allow you to bill when reporting hypothermia. If allowed, it can be billed along with either 00562 or 00563 for an additional five base units. However, some physicians opt not to bill the additional units for 00562 or 00563 even if it is allowed; they feel that adding units without specific justification is an invitation to an audit. And some carriers deem the billing of 99116 and 00563 simultaneously to be redundant (because 00563's descriptor includes hypothermia) and forbid it.

"Code 99116 specifies deliberate hypothermia used in conjunction with any anesthetic," says Abraham Rivera, MD, CEO of Pain Management Medical Group in Albany, N.Y. "It is specifically useful for brain surgery where even mild hypothermia has been proven beneficial, but I don't see the rationale for adding this code when 00563 is used. With code 00562 you can argue that the patient needed hypothermia for a specific reason, such as brain or myocardial protection because of poor cerebral or myocardial blood flow. In that case, adding 99116 would be reasonable."

Rivera sums up the distinctions between the codes: 00562 is used when the patient is on the cardiopulmonary bypass (CPB) machine and hypothermia is not used; coding and reimbursement should not present problems.

Code 00562 in conjunction with 99116 is for cases of CPB plus hypothermia used for cardioprotection or brain protection; this is the typical CABG [...]