Anesthesia Coding Alert

In 2001, anesthesiologists gained two codes for coronary artery bypass graft surgery (CABG): CPT 00563 (anesthesia for procedures on heart, pericardium, and great vessels of chest; with pump oxygenator with hypothermic circulatory arrest) and 00566 (anesthesia for direct coronary artery bypass grafting without pump oxygenator). Even though these codes are more specific, they still hold challenges.

Determining which code to use for the anesthesiologists service depends on two factors: whether the surgeon uses a pump oxygenator (commonly called the heart-lung machine) during the surgery and whether you have a detailed description of how the procedure was performed.

Note: The two original codes for CABG are 00560 (anesthesia for procedures on heart, pericardium, and great vessels of chest; without pump oxygenator) and 00562 ( with pump oxygenator). Although the 2001 codes replace these older ones, to process your claims some carriers might insist you use the old codes.

Did the Surgeon Use a Pump?

The majority of CABGs in our area are performed with a pump oxygenator, but were starting to see a small percentage without a pump, says Tonia Raley, CPC, a claims processing team leader with the Phoenix consulting firm Medical Information Management Solutions. The new codes, and the frequency of heart procedures without a pump, make it imperative for anethesia providers to chart which technique was used for the procedure. Coders need more specific information to match the more specific codes; they can no longer assume 00562 automatically applies.

When the pump is used, it keeps the patients blood flowing to the brain and other organs while the heart is stopped during surgery, explains Barbara Johnson, CPC, MPC, anesthesia coding specialist with the physician group Loma Linda Anesthesiology Medical Group Inc. in California. When the pump isnt used, the patients heart isnt completely stopped. This is a relatively new approach to CABGs that cuts down on the patients risks and includes benefits such as quicker recovery time.

Although anesthesias involvement in CABGs is the same in either case, coders must know which approach was used because the base units, and consequently reimbursement, for these codes differ. For example, if a patient undergoes a direct CABG without the pump oxygenator, it is coded with 00566, which has a base value of 25.

However, Raley sometimes finds that while local insurance companies allow the new 2001 codes for the procedure, Medicare carriers do not. In this case, the only alternative is to use the old 00560 code because it has a more general definition for procedures on the heart, pericardium and great vessels that dont use the [...]