Wiki Confusing surgery cancellation

[danidbreathe]

Hello, How do you code Anesthesia, if the patient went in for back surgery and the surgeon was entering anterior for a ACDF and accidently nicked the patients esophagus, the surgery is cancelled and a different surgeon is called in to repair the nick. In the meantime Anesthesia never stops and the whole procedure was over 2 hrs. Do we code for back surgery? but what about the additional time? Thank you for the help

 

[danachock]

Hi danidbreathe,
Per my Relative Value Guide received from the American Society of Anesthesiologists (page xi) it states: "when multiple surgical procedures are performed during a single anesthetic administration, only the anesthesia code with the highest base unit value (BVU) is reported. (The time reported is the combined total for all procedures.) Add on anesthesia codes are an exception to this policy. They are listed in addition to the code for the primary procedure."
This was very unfortunate; but you would ultimately bill the anesthesia procedure with the greatest amount of BVU's with the total amount of time.
Thanks for listening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB

 

[danidbreathe]

Hi danidbreathe,
Per my Relative Value Guide received from the American Society of Anesthesiologists (page xi) it states: "when multiple surgical procedures are performed during a single anesthetic administration, only the anesthesia code with the highest base unit value (BVU) is reported. (The time reported is the combined total for all procedures.) Add on anesthesia codes are an exception to this policy. They are listed in addition to the code for the primary procedure."
This was very unfortunate; but you would ultimately bill the anesthesia procedure with the greatest amount of BVU's with the total amount of time.
Thanks for listening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB

Thank you Dana!

 

[danidbreathe]

Hi danidbreathe,
Per my Relative Value Guide received from the American Society of Anesthesiologists (page xi) it states: "when multiple surgical procedures are performed during a single anesthetic administration, only the anesthesia code with the highest base unit value (BVU) is reported. (The time reported is the combined total for all procedures.) Add on anesthesia codes are an exception to this policy. They are listed in addition to the code for the primary procedure."
This was very unfortunate; but you would ultimately bill the anesthesia procedure with the greatest amount of BVU's with the total amount of time.
Thanks for listening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB

Hello Dana, I have a follow up question, my co-worker was wonder the guideline states "when multiple surgical procedures are performed..." however the one procedure (back surgery) was not performed, it was cancelled. Would this make us have to code for the esophagus repair?

 

[danachock]

Hi danidbreathe,
The back procedure was initiated, that is when the nicked esophagus occurred. I do not work in the patient advocate/risk management area at my facility. I have several years of anesthesia coding and denial experience to provide my advice. Have you reached out to them for any coding advice? I will tell you from working denials that most insurance companies will not pay for the anesthesia invoices until the primary procedure is paid.
"Typically" the back procedure would be billed with modifier 53 for discontinued procedure and the esophagus repair would also be billed with a modifier xx - since this does not sound like a return to the OR (because the patient never left the OR) with appropriate diagnosis code(s).
It would be important to know which surgical procedure or procedures are going to be allowed to be billed for you to bill the anesthesia. I have had the unfortunate opportunity to code this type of scenario and have always reached out to find out what primary procedure or procedure(s) will be billed.
I am unsure of your facility's policies. The advice you are looking for may not actually be from me but from within your organization. If your organization is only billing the esophagus repair (nothing related to the back procedure) due unforeseen events/circumstances. Once you are provided with what primary procedure code or codes are being allowed to be billed - you be be able to crosswalk your anesthesia code to the highest BVU.
I would caution on waiting a little longer for the correct answer(s), versus billing the wrong anesthesia code for this encounter.
Thanks for listening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB