Reader Question: Billing for Crossover Days   (September 2001)

Question: How should anesthesia be coded for a procedure that spans two dates of service? The surgery began at 11 p.m. and ended at 1 a.m.Illinois Subscriber
 Answer: According to Tammy Caldwell, an anesthesia coding team leader with the billing and consulting firm North Colorado Professional Services in Fort Collins, Colo. If your computer system can record “through” times, you can report both the start and end dates with a single entry by documenting the procedure’s [...]

You Be the Coder: Anesthesia or Surgical Codes for Epidurals   (September 2001)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Should we use anesthesia or surgical codes to report epidural injections (not labor)? Our physicians suggest appending modifier -AA (anesthesia services performed personally by anesthesiologist) or -QZ (CRNA service: without medical direction by a physician) to the claim, depending on who performs the procedure, but our claims are being denied.New York Subscriber

Answer: Epidural injections require a [...]

Reader Question: Piriformis Muscle TPI   (September 2001)

Question: What are the most appropriate CPT and ICD-9 codes for a trigger point injection to the right piriformis muscle?Arizona Subscriber  Answer: The most appropriate codes for the injection depend partly on the patients chief complaint and medical history. Code 64445* (injection, anesthetic agent; sciatic nerve) is for a nerve injection. Many coders may not be comfortable using a nerve injection code for a procedure performed on the piriformis muscle. Ask the physician to be more [...]

Reader Question: Myelography Coding Without Radiologist   (September 2001)

Question: An anesthesiologist performed a lumbar epidural injection with contrast dye and intraspinal myelography without spinal puncture. How should we code for this procedure in an ambulatory surgery center (ASC) when we have a technologist on staff but not a radiologist?Ohio Subscriber Answer: A code from 72240-72270 (myelography) should be used to report the radiological supervision and interpretation of the myelography, depending on the location. Because you do not have a radiologist on staff, you should [...]

Reader Question: Supporting Diagnosis: IV Access   (September 2001)

Question: What supporting diagnosis should be used for IV access by an anesthesiologist?Florida Subscriber
 Answer: There are many different possibilities for diagnosis. Part of your determination should be based on what your carrier prefers. One option that is often used for a primary diagnosis is 459.81 (venous [peripheral] insufficiency, unspecified). A secondary diagnosis could be related to many underlying problems such as leukemia (204.0X), acute myelogenous (205.0X) or any malignancy or metastatic disease process. Multiple trauma [...]

Reader Question: Anesthesia for Orthotripsy   (September 2001)

Question: Which code should I use for an orthotripsy (the ablation of a heel spur using laser)?California Subscriber
 Answer: Some physicians report it with 28899 (unlisted procedure, foot or toes), but 20979 (low intensity ultrasound stimulation to aid bone healing, noninvasive [nonoperative]) could also be appropriate. Ask your carriers if they require crossing the surgical codes to anesthesia codes. If so, 28899 becomes anesthesia code 01480 (anesthesia for open procedures on bones of lower leg, ankle, [...]

Reader Question: Long-Term Patient Care   (September 2001)

Question: What is the best way to code for a patient with long-term ICU or CCU care, such as ventilator management? Should we code for each day individually, or code the care weekly?Vermont Subscriber
 Answer: You should code each day separately because the supporting diagnoses may vary from day to day. The appropriate CPT codes can also change from one day to the next, depending on the amount of time spent with the patient and his [...]

Reader Question: Anesthesia for Balloon Kyphoplasty   (September 2001)

Question: Medicare will not pay for the anesthesia code that balloon kyphoplasty cross-references to (00640, anesthesia for closed procedures on cervical, lumbar or thoracic spine). Which codes are payable?Iowa Subscriber Answer: For a lumbar procedure, use 00630 (anesthesia for procedures in lumbar region; not otherwise specified) or 00300 (anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified). Although CPT doesnt explicitly state it, 00630 is [...]

Coding Ventilator Management Outside Global Anesthesia Services   (August 2001)

Beginning in 2001, CMS (formerly HCFA) bundled ventilation-management (VM) codes with inpatient-care codes, which means Medicare carriers no longer view VM as a distinct service. It is considered part of the anesthesia service if it is performed as maintenance during a patient’s surgical procedure. But there are circumstances outside the original procedure that allow billing it separately.
Ins and Outs of Ventilation-Management Codes
 Two CPT codes apply to VM: 94656 (ventilation assist and management, initiation of [...]

Separately Bill Post-Op Pain Management Ethically   (August 2001)

Billing for an anesthesiologist’s postoperative services – such as epidural analgesia, nerve blocks (a routine part of pain management beyond the surgical suite) and patient-controlled administration of analgesia – frequently challenges coders and billers, because these procedures are sometimes bundled with the surgical payment. The key to reimbursement is coding these services so Medicare and private carriers recognize them as separate and distinct from services of other providers, such as the surgeon.
Coding Postoperative Consults
 Cindy Parman, CPC, [...]