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Faster Preoperative Heart Rate Linked to More Postoperative Myocardial Injury

Postoperative myocardial injury is correlated with increasing resting preoperative heart rate in noncardiac surgery patients, according to a new study. Interestingly, the researchers concluded that the relationship may be J-shaped instead of linear, demonstrating that abnormally low heart rates may be potentially dangerous, too. “One of the theories about myocardial injury is that heart rate, […]

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Anesthesia Coding: Find the Missing EGD Reimbursement Link

Warning: Just including EGD diagnosis with your claim doesn’t guarantee reimbursement — here’s help.

Question: Our anesthesiologist provided anesthesia during an esophagogastroduodenoscopy (EGD) procedure, at the request of the attending physician. We coded the anesthesia portion with 00810. A note in the documentation mentions the request was due to the patient’s symptoms, but no other details were provided. The claim we submitted was denied, but we followed all of the other guidelines provided by the payer, including proof that the anesthesiologist administered Propofol. What did we do wrong?

Answer: One key to the denial might be found in the lack of coding for the patient’s condition. Your diagnosis code should indicate the co-existing medical condition that justifies your anesthesiologist’s involvement in the case, not the gastrointestinal condition leading to the endoscopy.

You may want to consult with your anesthesiologist to verify that the patient had a condition such as:

  • Parkinson’s disease (332.0)
  • Heart conditions (such as 410.xx, Acute myocardial infarction or 427.41, Ventricular fibrillation)
  • Mental retardation (318.x)
  • Seizure disorders (such as 780.39, Other convulsions)
  • Anxiety (such as 300.0x, Anxiety states)
  • Pregnancy
  • History of drug or alcohol abuse.

These are just some of the conditions that payers may require to justify the presence of an anesthesiologist at a colonoscopy. ICD-9 2010 also has two codes to describe failed sedation attempts: 995.24 (Failed moderate sedation during procedure) and V15.80 (Personal history of failed moderate sedation).

If your anesthesiologist’s documentation confirms one of these conditions, 995.24 or V15.80 would also justify an anesthesiologist’s involvement to most payers. The conditions listed above constitute the medical necessity of anesthesia with the procedure. If you used a screening diagnosis or treatment of commonly found conditions instead of the clinical condition requiring anesthesia, payers will not pay you for these services.

Also note the…

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Employ Modifier 53 For Discontinued Anesthesia Services

Pain management specialties might make use of modifier 52 as well.

The situation is bound to happen: A patient undergoing surgery has complications, and your anesthesiologist must stop his services. Are you prepared to recognize a situation that calls for…

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Mind Your P Modifiers or Leave Money on the Table

Have your documentation ready for reporting level P4 and higher.

Physical status modifiers, also referred to as P modifiers, PS modifiers, ASAs or ASA P codes, are an important element of your anesthesia coding. If you don’t use them correctly,…

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Burn Coding: Calculate Total Body Surface Area (TBSA)

Investigate your physician’s documentation to determine the body area percentage actually debrided.
Question: My anesthesiologist administered anesthesia for a burn excision on the leg of a middle-aged adult male, but he didn’t give clear notes on the patient’s affected body surface area. How do I code for this?
Kansas Subscriber
Answer: You will start by coding 01952 (Anesthesia […]

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