Anesthesia Coding Alert

Check these 3 areas before coding your next claim Performing eye surgery can be quick and easy (comparatively speaking) for surgeons, but coding your anesthesia providers' work is never cut-and-dried.

A physician administers a pain block before the eye surgery begins, and a physician or other qualified anesthesia professional monitors the patient during the procedure. Knowing who is involved with each portion of the procedure from an anesthesia standpoint ensures you code correctly. Understand What's Happening  "Facilities see a high volume of these cases performed almost exclusively as outpatient procedures," says Darlene Ogbugadu, CPC, an anesthesia coding supervisor with Northwestern Medical Faculty Foundation in Chicago. "They usually involve the administration of a local anesthetic in addition to systemic sedation and blocks administered by the anesthesiologist."

Diagnoses leading to eye surgery can include cataracts (366.xx), glaucoma (365.xx), strabismus (378.xx) and retinal detachment (361.xx).

"Retrobulbar blocks are useful methods of achieving anesthesia for intraocular and orbital surgeries," Ogbugadu adds. "These blocks are good alternatives to general anesthesia when general anesthesia is undesirable or contraindicated."
 
Case 1: Anesthesiologist Places the Block, CRNA Observes  Some facilities prefer to have the anesthesia team handle all aspects of eye surgery anesthesia. If so, the anesthesiologist sometimes places the initial block but assigns a CRNA to observe the case once it begins.

In years past, some coders in this situation reported the retrobulbar block with 67500 (Retrobulbar injection; medication [separate procedure, does not include supply of medication]) in addition to the procedure's anesthesia. But problems can arise with this stance once the anesthesiologist hands off the care to the CRNA, so many of today's coders don't code the block itself.

"Most carriers consider billing the retrobulbar blocks in addition to the anesthesia time and base units as bundling and not payable," Ogbugadu says. "We do not bill for the block."

Instead, only report the correct procedure code:

• 00140 -- Anesthesia for procedures on eye; not otherwise specified
• 00142 -- ... lens surgery
• 00144 -- ... corneal transplant
• 00145 -- ... vitreoretinal surgery. Add MAC: You should also report the appropriate MAC (monitored anesthesia care) modifiers for the case, depending on your carrier's guidelines. Always append modifier QS (Monitored anesthesia care service) to the code, and add modifier G9 (Monitored anesthesia care for patient who has history of severe cardiopulmonary condition) when appropriate.

Note: MAC modifier G8 (Monitored anesthesia care [MAC] for deep complex, complicated or markedly invasive surgical procedure) applies to some cases but shouldn't come into play with eye surgeries unless something about the procedure merits a "markedly invasive" designation.

"Our surgeons prefer MAC anesthesia for these cases because 80 percent of our cases are aged patients," says Vicki Embich, a coding [...]