Wiki Diagnosis Coding for Anesthesia Claims

[shari1264]

This is a question for those who code anesthesia for hospitals or outpatient surgery centers. How many diagnosis codes do you put on your claims; in other words, do you code them like you would code the surgery or an OP/IP visit with up to 12 diagnosis codes, including HCC codes. I have my CPC and CANPC credentials.

I was taught to code the reason(s) for the surgery, and if necessary, codes to support MAC and/or P3-P5 modifiers. I have coded for a private anesthesia billing company and now a hospital. I have never been audited by someone who doesn't code anesthesia and was told a few different things that are incorrect regarding anesthesia coding (told to put surgery modifiers on claims, for instance), but I was also dinged for not including all of the hospital visit codes (one had 24 diagnosis codes!)

 

[thomas7331]

I've worked for one facility that wanted only the diagnosis codes related to the surgery itself, and another one that wanted a code for every condition documented anywhere in the record of the encounter, up to the number of codes that could be billed on the claim. The company you're working for should direct you on what their expectations are, and their auditors' process should align with this so that they're not citing you for errors when you're correctly following the company's process. But if an employer doesn't have a written policy, then in the absence one I would just fall back on the ICD-10 guidelines and code those conditions that are documented as requiring or affecting treatment at the encounter.

 

[shari1264]

I've worked for one facility that wanted only the diagnosis codes related to the surgery itself, and another one that wanted a code for every condition documented anywhere in the record of the encounter, up to the number of codes that could be billed on the claim. The company you're working for should direct you on what their expectations are, and their auditors' process should align with this so that they're not citing you for errors when you're correctly following the company's process. But if an employer doesn't have a written policy, then in the absence one I would just fall back on the ICD-10 guidelines and code those conditions that are documented as requiring or affecting treatment at the encounter.

Thank you for your response. The lack of a clear policy is part of the frustration. For the first time in years, we just got a manager who actually knows anesthesia coding and is trying to undo some of the things that have been done in prior years when the department managers had no experience in coding anesthesia. The auditors comments go directly against the coding guidelines you cited regarding conditions that are the reason for the encounter that requires some mode of anesthesia.

 

[thomas7331]

Thank you for your response. The lack of a clear policy is part of the frustration. For the first time in years, we just got a manager who actually knows anesthesia coding and is trying to undo some of the things that have been done in prior years when the department managers had no experience in coding anesthesia. The auditors comments go directly against the coding guidelines you cited regarding conditions that are the reason for the encounter that requires some mode of anesthesia.

This is a common frustration, especially in larger organizations. It's unfortunate when managers don't recognize the need to set clear guidance for coders because the lack of it creates confusion, negatively impacts productivity, reduces job satisfaction, and hurts morale. And failure to require auditors to align with coders on policy just compounds the problem. Part of issue, I think, is that managers who don't have background in coding just don't understand some of the issues, which means it falls to coders to try to educate and influence their managers ('managing up' was what one of my colleagues used to call this) or alternatively to just give up if the managers aren't willing to invest the necessary time into developing a process. Be patient and persistent and hopefully you will see some change for the good!