Anesthesia Coding Alert

Alabama Subscriber

Answer: If only one procedure was performed on two patients, as is most likely the case with conjoined twins, you should bill both with the same anesthesia code, such as 00192 (Anesthesia for procedures on facial bones or skull; radical surgery [including prognathism]) if the babies are joined at the head and being separated.

Conjoined twins have blood vessels that cross from Baby A to Baby B. Therefore, you have two patients, although most hospitals will have one medical record until they are separated. Bill both with the same anesthesia code, but report the reason for the catheter for Baby B and report "conjoined twins" (678.1x, Fetal conjoined twins,) for Baby A.

Prepare for appeal: You may have to lodge an appeal with the insurance company, but you can get paid for two cases. In your documentation, specify that the anesthetic drugs will affect both babies by crossing from Baby B to Baby A, and therefore, you had two cases.

Remember: You'll also want to include qualifying circumstance codes, such as +99100 (Anesthesia for patient of extreme age, younger than 1 year and older than 70 [List separately in addition to code for primary anesthesia procedure]).