Anesthesia Coding Alert

Note: Please consult CPT 2001 for final and complete information. The codes listed in this article are simply a preliminary look at new and revised anesthesia codes.

Although CPT 2000 brought few major changes to codes in the anesthesia section (no new codes, 13 revisions, and 11 deletions), CPT 2001 will incorporate many more changes. This year there are 10 new codes,13 revised codes and two deletions.

All of the anesthesia revisions fell into one of 11 categories proposed by representatives of the American Society of Anesthesiologists (ASA). Stanley W. Stead, MD, a California anesthesiologist and a member of the American Medical Associations (AMA) CPT editorial board, says the revisions are designed to make coding for anesthesia services more specific and accurate.

New Anesthesia Codes

New codes for 2001 relate to areas ranging from cardiac electrophysiologic procedures to cervical spine procedures, bone marrow aspiration or burn excision. Although descriptors are listed below, take this list as information only and refer to the actual CPT 2001 for final codes. The new codes are listed below, including sample vignettes and other information.

Intrathoracic

CPT 00537 anesthesia for cardiac electrophysiologic procedures including radio frequency ablation

Cardiac electrophysiologic procedures are relatively new, yet the depth and breadth of these procedures are rapidly expanding. Suppose you have a patient in good general health who complains of palpitations and an occasional shortness of breath not associated with activity. An electrocardiogram showed findings consistent with Wolff-Parkinson-White syndrome (WPW). Given that patients with WPW are at increased risk for fatal rhythm disturbances, you schedule the patient for cardiac electrophysiologic studies and possible ablation of the aberrant pathways. Use 00537 to code the anesthesia.

00550 anesthesia for sternal debridement

Anesthesia for sternal debridement that involves surgical procedures differs from procedures represented by the current codes, 00540 (anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and madiastinum [including surgical thorascopy]; not otherwise specified) and 00560 (anesthesia for procedures on the heart, pericardium, and great vessels of chest; without pump oxygenator).

Sternal debridement involves the mediastinum and pleura, as well as possibly including the pericardium, heart and sternum. In this scenario, a patient suffers penetrating trauma of the thorax that results in a cardiac injury requiring median sternotomy for surgical repair. On the sixth postoperative day, splitting of the sternal wound was noted, so the patient was returned to the operating room for wound debridement use code 00550 for the anesthesia.

00563 anesthesia for procedures on heart, pericardium and great vessels of chest; with pump oxygenator with hypothermic circulatory arrest

00566 anesthesia for direct coronary artery bypass grafting without the pump oxygenator

Codes 00560 (anesthesia for procedures on heart, pericardium, and great vessels of chest; without pump oxygenator) and 00562 ( ... without pump oxygenator) are now being used to report coronary artery bypass grafting, but are being used inconsistently because they do not accurately describe or represent the new procedure of direct coronary artery bypass grafting. This new procedure involves surgical steps that require new approaches to anesthesia delivery.

00570 electrocardiography, transesophageal (TEE), for monitoring purposes, including probe placement, real time two-dimensional image acquisition and interpretation leading to ongoing assessment of cardiac function and therapeutic decisions on an immediate time basis. Use in addition to anesthesia procedure.

Many Medicare carriers have local reimbursement policies regarding TEE, but most do not specify how it relates to anesthesia (see Codify Anesthesia Coding Alert, June 2000, page 44). The only CPT codes related to TEE were surgical codes, which some carriers will not accept from an anesthesia provider. Anesthesia providers have had difficulty being reimbursed for their involvement in the procedure. The goal of the new code is to help anesthesiologists acquire reimbursement for TEE.

Spine and spinal cord

00635 anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture

Pelvis (except hip)

01112 anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest

Upper leg (except knee)

01215 anesthesia for open procedures involving hip joint; revision of total hip arthroplasty

The existing code used for anesthesia care of total hip arthroplasty revisions is 01214 (anesthesia for all closed procedures involving hip joint, total hip replacement or revision). The new code will be implemented because the anesthesia required for a patient undergoing total hip arthroplasty revision is significantly different than for a de novo hip arthroplasty. Additional steps related to cementing the prosthetic components make the surgery more painful, more difficult and more time-consuming than a primary procedure. Blood loss is greater and happens more quickly, and patients are more likely to suffer more pronounced hemodynamic instability.

The new code will apply for anesthesia in the following scenario. A patient presents who had cemented total hip arthroplasty one year ago. After recovery from the first total hip replacement, she suffered two dislocations of the same hip. Radiographic studies reveal loosening of the femoral component. The patient is admitted for surgery to remove and replace the femoral component, and to assess and possibly replace the acetabular components to prevent further dislocations.

Burn excisions or debridement

01951 anesthesia for second and third degree burn excision or debridement with or without skin grafting, any site, for total body surface area (TBSA) treated during anesthesia and surgery; less than one percent of total body surface area

01952 ... one percent to nine percent total body surface area

01953 ... each additional nine percent total body surface area or part thereof (list separately in addition to code for primary procedure)

Burn management provides a unique set of challenges to the anesthesiologist. Perioperative risks are related to burn size, while pulmonary injury, systemic infection that may lead to sepsis and major fluid loss are possible complications. An example for using any of these three new codes is: A 34-year-old female is burned by a cooking oil fire over the face, neck, anterior chest, forearms and hands. The patient is in extreme pain from her chest burns, but reports no pain on the face, neck, forearms or hands. She has obvious charred tissue over the anesthetic tissue in the face, neck, forearms and hands. The patient is brought to the operating room for debridement and dressing of the wounds under general anesthesia.

Echocardiography

93318 echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time two-dimensional image acquisition and interpretation leading to ongoing assessment of cardiac function and therapeutic decisions on an immediate time basis

Use in addition to anesthesia procedure.

Revised Anesthesia Codes
The purpose of revising codes is to ensure that they accurately reflect the procedures being reported with them. The following codes reflect the changes in CPT 2001.

Head

00145 anesthesia for procedures on eye; vitreo retinal surgery

00190 anesthesia for procedures on facial bones or skull; not otherwise specified

00215 anesthesia for intracranial procedures; cranioplasty or elevation of depressed skull fracture, extradural (simple or compound)

Intrathoracic

00530 anesthesia for permanent transvenous pacemaker insertion

00534 anesthesia for transvenous insertion or replacement of pacing cardioverter/defibrillator

Spine and spinal cord

00604 anesthesia for procedures on cervical spine and cord; procedures with patient in the sitting position

00670 anesthesia for extensive spine and spinal cord procedures (e.g., spinal instrumentation or vascular procedures)

Upper abdomen

00792 anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; partial hepatectomy or management of liver hemorrhage (excluding liver biopsy)

Perineum

00902 anesthesia for anorectal procedure

00920 anesthesia for procedures on male genitalia (including open urethral procedures); not otherwise specified

00942 anesthesia for vaginal procedures (including iopsy of labia, vagina, cervix or endometrium); colpotomy, colpectomy, colporraphy and open uretheral procedures

Upper leg (except knee)

01214 anesthesia for open procedures involving hip joint; total hip replacement

Lower leg (below knee, includes foot and ankle)

01482 anesthesia for open procedures on bones of lower leg, ankle and foot; radical resection (including below knee amputation)

Deleted Codes

Two codes in the anesthesia section have been deleted from CPT 2001.

Upper arm and elbow

01784 anesthesia for repair of arteri-venous (A-V) fistula, congenital or acquired This code was deleted because of its similarity to 01770 (anesthesia for procedures on arteries of upper arm and elbow; not otherwise specified). Code 01770 represents the general case, while 01784 represents a small subset of cases. Both codes have the same relative value unit, and ASA representatives did not believe the specificity of code 01784 was necessary. Providers will be redirected to report services with 01770 instead.

Perineum

00900 anesthesia for procedures on perineal integumentary system (including biopsy of male genital system); not otherwise specified

ASA and CPT representatives believe 00900 represented redundant reporting of procedures that fall under codes 00300 (anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck and posterior trunk; not otherwise specified) and 00400 (anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified). Providers will be redirected to report services with either 00300 or 00400 as appropriate.

Other Important Revisions

Two other significant changes will be incorporated into CPT 2001. First, nomenclature will be consolidated within CPT, including in the anesthesia section. For example, the following changes will be made:

spinal to cerebrospinal,
pericardium to pericardial sac,
arteriography to angiography, and
knee replacement to knee arthroplasty.

Second, the code for emergency anesthesia procedures (99140, anesthesia complicated by emergency conditions) is being used outside its intended use. Some anesthesia providers have been reporting all cases performed after 3 p.m. and any cases performed on weekends as emergencies, and coding them with 99140. The intent of 99140 is to indicate those procedures that are emergencies as defined in CPT, ... when delay of treatment of the patient would lead to a significant increase in the threat to life or body part. As such, the CPT panel felt a need to include additional language to the codes definition to exclude potential abuse.