You Be the Coder: Removal of Ear Tubes   (August 2001)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Our anesthesiologists often assist when children return to our hospital to have tubes removed from their ears. We code this with either 69205 (removal foreign body from external auditory canal; with general anesthesia) or 69610 (tympanic membrane repair, with or without site preparation or perforation for closure, with or without patch) for a paper patch – [...]

Use New, Specific Codes for Endovascular Repair of AAA   (August 2001)

Until the release of CPT 2001, endovascular repairs for abdominal aortic aneurysm (AAA) were billed with the unlisted-procedure code 37799 (unlisted procedure, vascular surgery), because there were no specific codes for these procedures. Now that unique codes are in place, such as 34800 (endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-aortic tube prosthesis), 34802 (… using modular bifurcated prosthesis [one docking limb]) and 34804 (… using unibody bifurcated prosthesis), anesthesiology coders must [...]

Reader Question: Billing for Monitoring Service   (August 2001)

Question: A patient presented for an emergency colonoscopy. No sedation was used, but our anesthesiologist monitored the patient during the procedure. Can we bill this monitoring service?  Maine Subscriber Answer: The service you describe is usually considered standby and is generally included in the facility charge. Most carriers, including Medicare and most Medicaid, will not pay an anesthesiologist for standby service. Monitoring the patient without administering anesthesia or medications leads to the question of whether the [...]

Reader Question: Coding for Prolotherapy   (August 2001)

Question: How should we code prolotherapy?California Subscriber Answer: Prolotherapy, also known as sclerotherapy, is a series of injections into soft tissue or tendons to treat back, neck or joint pain. Medicare does not cover this procedure, but private payers might accept codes for tendon injections such as 20550* (injection, tendon sheath, ligament, trigger points or ganglion cyst). Because no CPT code specifically applies to the procedure, your other option is to use 90799 (unlisted therapeutic, prophylactic [...]

Reader Question: Billing for Second Anesthesiologist Assist   (August 2001)

Question: One of our anesthesiologists encountered a patient who was very difficult to intubate and received considerable help from one of the other doctors to do a fiberoptic intubation. Can the second doctor bill for the assist?Indiana Subscriber Answer: Some carriers might pay the second physician at a reduced rate, and other carriers (such as Medicare) might not pay at all, but it’s worth filing to see if you can get at least partial reimbursement for [...]

Procedural Stages for Intrathecal Pumps Provide the Key to Successful Coding   (July 2001)

The three-stage process of using a permanent implantable pump (trial insertion and evaluation, permanent placement, and ongoing maintenance) can present a significant coding dilemma for anesthesia practices. The challenge is that how each stage is performed largely determines how the next one is coded.  Clearing Up Trial-pump Coding (Stage One) “During a trial, you’re trying to demonstrate that the implantable pump (intrathecal or infusion) is the way to go for a patient,” explains Abraham Rivera, MD, [...]

You Be the Coder: Sheathectomy   (July 2001)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
 
Question: A physician performed a sheathectomy on the retinal vein for occlusion. Which surgical and anesthesia codes would be appropriate?
Pennsylvania Subscriber
 

Answer: The surgical code is partly determined by the method of excision (cutting, laser or diathermy) and what caused the occlusion. For example, if the occlusion were caused by a lesion, use code 67208 (destruction of [...]

Intubation and Anesthesia for Laryngoscopy, Bronchoscopy   (July 2001)

Laryngoscopies and bronchoscopies are performed fairly frequently, especially to diagnose respiratory ailments or clear newborns’ airways. In some of these cases, an anesthesiologist might have to perform an intubation as a separate procedure or provide general anesthesia in conjunction with the laryngoscopy or bronchoscopy. However, under CPT’s anesthesia guidelines, laryngoscopy (31505-31579) and bronchoscopy (31622-31656) are bundled codes, which usually do not include administration of general anesthesia nor permit billing intubation as a separate procedure. The [...]

Legislative Update: CRNA Rule Postponed   (July 2001)

In the May 18 Federal Register, Health and Human Services (HHS) Secretary Tommy Thompson announced the decision to delay until November a final Medicare rule that would allow CRNAs to provide anesthesia without physician supervision. 
HHS said it would propose a new rule that would continue to require physician supervision “generally.” However, a governor could exempt a state from this requirement after proving that the exemption is in the best interest of the state’s citizens. 
Proving the [...]

“You Be the Coder” Update: Which Code Is Right for 15736   (July 2001)

Because the answer to the May question (”Which anesthesia code corresponds with grafting procedure 15736 [muscle, myocutaneous, or fasciocutaneous flap; upper extremity]?”) prompted several inquiries and much interest, Anesthesia Coding Alert consulting editor Barbara Johnson, CPC, MPC, professional coder with Loma Linda University Anesthesiology Medical Group Inc. of Loma Linda, Calif., chose to discuss the issue further.   
Codes 15732-15738 are the only four in the CPT grafts and flaps section that use the donor rather than [...]