Wiki Anesthesia for 21558

zy.ivey

New
Messages
8
Location
Riverton, WY
Best answers
0
I am really new to anesthesia coding and cannot find my answer anywhere. The crosswalk for code 21558 brings up 3 codes: 00300, 00320, and 00400. Our outsourced coders picked 00400, but medicare denied due to the LCD. I am wondering if 00320 would be a better fit. The diagnosis code is 173.52 and v10.83.

So in summary my base question is how do you pick the correct anesthesia code? What instances would you use 00300 with 21558, 00320 with 21558, and 00400 with 21558? Why would it work in those instances and not others? I am so confused and would really appreciate help. :confused:
 
Actually I think 00300 is the right choice as it deals with the NECK.

I see nothing in your message that refers to: esophagus, larynx, trachea, or lymph. (00320) or extremities of the thorax (00400)
 
I noticed the procedure was done on the neck, but the dx code is for squamous cell carcinoma of the trunk. That may be your problem.

If the neoplasm was on the neck, use 173.41 as your dx code.
If this is the case, I'd use 00300 for the anesthesia code.

Here's a breakdown of the anesthesia codes that crosswalk from 21558:

00300 - Anesthesia for all procedures on the integumentary system, muscles & nerves of HEAD, NECK, & POSTERIOR TRUNK, NOS

00320 - Anesthesia for all procedures esophagus, thyroid, larynx, trachea & lymphatic system of neck; NOS, age 1 yr or older [Basically all things under the skin in this area]

00400 - Anesthesia for procedures on the integumentary system on the extremities, ANTERIOR TRUNK & PERINEUM; NOS
 
Last edited:
The code 21558 is "radical resection of tumor (eg. sarcoma), soft tissue of neck or anterior thorax; less than 5 cm." Path came back as 173.52

The op report:
A time out was performed by the surgical team to confirm the
correct patient, site, and procedure. We confirmed that antibiotic prophylaxis was given. Once this was done, the chest was prepared and draped in the usual sterile manner. Xylocaine plain 0.5% was used in a field block technique. A total of 38 mL was used to anesthetize around the lesion. We made an elliptical incision which was approximately 7 cm x 5 cm. We raised skin flaps based on this incision and dissected down through the superficial fascia to the pectoralis fascia to the pectoralis fascia which was removed from the pectoralis muscle to obtain negative margins. In the midline, we were down to periosteum of bone. We completely excised the lesion. We marked it with a short suture superiorly and a long sutures laterally Marking left and right and passed it off for pathologic examination. Hemostasis was effected with the electrocautery and with absorbable Vicryl sutures. One this was done, the wound was closed in layers with absorbable sutures. Steri-Strips were placed. A sterile, occlusive dressing was placed. The
final needle and sponge count was reported as correct x2 and the patient was transferred back to the same day surgical suite and observed for 30 minutes until a return to baseline state was observed. The postoperative plan includes respiratory prophylaxis, close observation, and early ambulation.
 
I understand now why they picked 00400 :) i hadn't looked up the op report i was trying to figure it out off memory. I appreciate the help. Its still a bummer because per medicare lcd 173.52 does not support 00400.
 
Top