Anesthesia Coding Alert

Question: We have a new anesthesiology client who works in an eye center. He says that he does all blocks and no general anesthesia for the eye surgeries. Should I use a code from range 00140-00148 or a code such as 64400?

Washington Subscriber

Answer: Assuming your anesthesiologist is acting as the anesthetist for the eye surgery and is not the provider performing the actual eye surgery, and that his primary anesthesia technique for all eye procedures is a bulbar block instead of general anesthesia to anesthetize his patients, then the prime anesthesia technique is a block.

If your anesthesiologist only does the block and nothing else, he is providing a surgical service: either 64400 (Injection, anesthetic agent; trigeminal nerve, any division or branch) or 67500 (Retrobulbar injection; medication [separate procedure, does not include supply of medication]).

If he does the block and anesthesia, he can bill the time for the block and all the time plus base value for the procedure 00142 (Anesthesia for procedures on eye; lens surgery) if the surgery is for a cataract.

The American Society of Anesthesiologists (ASA) code assigned to the actual anesthesia service depends on the type of procedure being performed. For example, a cataract extraction would be coded by CPT as 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [1 stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]) and crosswalk to ASA 00142.

Count your units: ASA 00142 is valued at four base units. You will need to know the anesthesia start and stop times to determine your anesthesia charge, using the formula base units plus time, multiplied by conversion factor.

Always verify the procedures your anesthesiologist performs to verify what he means in his documentation.

-- Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; and Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.