Anesthesia Coding Alert
Change Code for Nuss Bar Removal
Oklahoma Subscriber
Answer: Code 21899 is the correct surgical code for Nuss bar removal, but sometimes you have to change the anesthesia code to fit the procedure rather than automatically follow the Crosswalk - this is one of those times. Notice that the Crosswalk includes "I.C." with the descriptor for 01999. "I.C." stands for "individual consideration," and means that the carrier will determine the procedure's base units. The American Society of Anesthesiologists (ASA) doesn't recommend a single base unit allowance because of the number of procedures that could be assigned this unlisted-procedure code.
In this case, report 00540 (Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum [including surgical thoracoscopy]; not otherwise specified) because the bar is attached to the sternum. Link 00540 to V54.0 (Other orthopedic aftercare; aftercare involving removal of fracture plate or other internal fixation device) or 996.78 (Complications peculiar to certain specified procedures; other complications of internal [biological] [synthetic] prosthetic device, implant, and graft; due to other internal orthopedic device, implant, and graft), depending on whether the bars are causing problems or simply being removed. Report the reason for original surgery as your second diagnosis.
Code 00540 has 12 base units, which some coders believe is high for this procedure, especially if the surgeon didn't enter the chest (thoracic) cavity. If you think you should reduce the number of units, report 00540 with modifier -52 (Reduced services) and adjust the base units accordingly.
Another option is to report 01999 (Unlisted anesthesia procedure[s]), but carriers prefer that you report a more descriptive code whenever possible instead of using unlisted-procedure codes.
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