Anesthesia Coding Alert

Although many medical plans used to include coverage for dental services, that's rarely the case these days, and reimbursement for anesthesia during dental procedures can be unreliable. By knowing which set of codes the carrier wants and what type of documentation it requires, you're one step closer to being reimbursed.Document Medical Necessity for AnesthesiaThe most frequent problem many coders have with dental reimbursement is the carrier's questioning the need for anesthesia at all.

 As with any case, ensure that documentation shows medical necessity for performing the services under anesthesia. The complexity of the procedure as documented by the dentist and/or oral surgeon combined with the anesthesiologist's documentation should be thorough enough to substantiate your claim, says Valerie Puckett, BS, CPC, manager of compliance and reimbursement, professional services, of St. Jude's Children's Research Hospital in Memphis, Tenn.                                                                                          

What types of situations help support anesthesia's necessity? Sometimes the patient's age or health status justifies it no matter what procedure the dentist or oral surgeon performs.Puckett's practice sees many children who require sedation or anesthesia for dental procedures. Many of the children at St. Jude's require fillings, crowns and tooth extractions as a result of radiation oncology and chemotherapy," she explains. Because a dentist or oral surgeon performs these types of procedures as part of cancer treatment, the patient's medical insurer usually covers them, and standard medical rules apply.                                                                                  

 "Most of our procedures are performed under general anesthesia due to the patient's age," Puckett says. "We may also provide anesthesia if the patient is uncooperative or if there will be multiple extractions, root canals or other procedures during the same session."                                                                         

Patient preference may influence whether anesthesia is used during a procedure, says Gerry Malloy, coder with Lehigh Anesthesia Associates in Allentown, Pa. And from a practical standpoint, he adds that some dentists find that they can complete more cases if a separate anesthesia provider is involved.Know the Patient's Plan DetailsThe most appropriate codes to use and the likelihood of reimbursement largely depend on whether you're dealing with a medical plan or a dental plan.          

"Dental plans are usually only familiar with the HCPCS dental codes," Malloy says. "We usually have to bill with dental codes D9220 (Deep sedation/general anesthesia first 30 minutes) and D9221 ( each additional 15 minutes), though they don't have very good reimbursement." (Several other HCPCS codes relate to dental anesthesia, but D9220 and D9221 describe the most common procedures.)

 If a medical plan covers the procedure instead of dental, Malloy bills with ASA or CPT surgical codes, depending on the carrier's requirements. Anesthesia coders use 41899 (Unlisted procedure, dentoalveolar structures) and 00170 (Anesthesia for intraoral procedures, including biopsy; not otherwise specified) most often in this

 "Medical plans seem [...]