Anesthesia Coding Alert

From diagnostic procedures through surgery and breast reconstruction, the anesthesiologist is a key member of a patient's breast-cancer care team. While much of the coding associated with the diagnosis and treatment can be straightforward, knowing how to report services performed by the anesthesiologist can be tricky.
Biopsies and Anesthesia Services
When breast cancer is suspected, the anesthesiologist may provide services associated with biopsy and staging. Beth Hibbs, CCS-P, an American Health Information Management Association certified coder in Spokane, Wash., notes that biopsies include local or intravenous sedation, and sometimes monitored anesthesia care (MAC), for certain procedures. Scott Groudine, MD, an anesthesiologist in Albany, N.Y., says that the administration of local anesthesia is usually performed by the surgeon and thus included in the global surgical fee. "Almost every Medicare carrier considers anesthesiology services unnecessary when local anesthesia is used. While an anesthesiologist may put in a local, they must also provide MAC or general anesthesia to justify the medical necessity for billing the service."
 
Hibbs says, "The majority of biopsies performed in our area fall under 19125 (Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion). Two additional codes also define common biopsy procedures 19102 (Biopsy of breast; percutaneous, needle core, using imaging guidance) and 19103 ( percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance)."
 
For the anesthesiologist, all of the procedures noted above can be coded using the appropriate surgical and anesthesia code 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified), which carries a base value of three units plus time. Groudine warns, however, that 19102-19103 describe minimally invasive procedures that rarely require an anesthesiologist's services. "If an anesthesiologist bills for these procedures, the claim is likely to be denied. Worse yet, routine submission of anesthesia claims for these procedures may prompt local Medicare carriers to develop local medical review policies (LMRPs) which severely restrict anesthesia reimbursement for breast services."
 
Mary Jo Marcely, CPC, senior vice president of NAPA Services, a consulting and medical billing firm in Syracuse, N.Y., advises coders to check their LMRPs and the guidelines of other carriers when using MAC. "Many LMRPs require appending modifiers to the anesthesia code. These might include modifiers -QS (MAC service), -G8 (MAC for deep complex, complicated, or markedly invasive surgical procedure), or -G9 (MAC for patient who has history of severe cardio-pulmonary condition)."
 
"For more invasive procedures, such as 19101 (Biopsy of breast; open, incisional), administration of MAC or general anesthesia is the norm," Hibbs says. In this case, coders should submit claims using 19101 and 00400 (and a MAC modifier if necessary).
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