Anesthesia Coding Alert

Question: The anesthesiologist provided anesthesia services for creation of a pericardial window. Documentation indicates the pump oxygenator wasn’t used. If anesthesia started at 8:00 a.m. and ended at 9:15 a.m., how many units should I report?

Utah Subscriber

Answer: You should report 20 units in this case. Start by determining the correct anesthesia code, which in this case is 00560 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator). The descriptor indicates the code is appropriate for anesthesia for procedures on the pericardial sac (a sac around the heart) without a pump oxygenator.

Code 00560 has 15 base units according to both Medicare and the American Society of Anesthesiologists. Anesthesia time lasted 75 minutes. Assuming your payer uses 15-minute increments, then 75 minutes equals 5 time units.

In this case, the total units are calculated as follows: 5 time units + 15 procedure base units = 20 total units of billable anesthesia.

Tip: If your payer allows additional payment for physical status modifiers or qualifying circumstances, be sure these elements are documented, reported, and calculated, as well.