Medical Coding: Accurate Diagnosis Coding Principles for Anesthesia

Read this expert medical billing and coding training article and get a solid foundation of diagnosis coding for anesthesia services.

Work-related injuries

You want to make certain that you're appending current injury codes when it's a work-related injury. For example, you wouldn't expect to see arthritis chronic if it's a work-related injury. You would look for that code that relates to why the anesthesia provider is providing services for a work-related injury.

That doesn't necessarily mean you must report the E-codes which are the additional information codes that help the insurance carriers understand how they got injured. Those are typically reported by the surgeon.

Medical Coding Training Tip: It's not a bad thing to code the E. It's just often a waste of time. It's good exercise for coding conventions but many of the insurance companies will pay your anesthesia work-related injuries with just a primary that explains the current injury code.

Combination codes

If you have both chronic tonsillitis and adenoiditis, there is one specific code to explain that. You would not separate out 474.00 and 474.01.

A combination code from Chapter 11 is defined as a single code used to classify either two diagnoses, a diagnosis with an associated manifestation or a diagnosis with an associated complication. So you wouldn't pull those out and single code them if there is one code that explains both.

The concept applies to more than just tonsillitis but that's an excellent example for an anesthesia claim. Should you report up to four ICD 9 codes? No.

Anesthesia is fairly straightforward in that the patient needs to be put to sleep most of the time for the surgery that they're having. There may be some questionable circumstances related to what are known as “Column B procedures”. But for the most part, the patient is having anesthesia because they're having surgery that requires it.

So if you are tying the diagnosis for the surgery and with the procedure the patient is having, you should not have to routinely add extra codes. We are not paid by DRGs. We don't get paid extra for having all those codes on there.

Sometimes they just complicate things and muddle things up and leave you open for denials if you choose wrong codes that don't correspond with what the surgeon is reporting because the surgeon may be reporting up to four medical codes routinely.

The exception here is if you're trying to justify a physical status and obesity for BMI, maybe you're trying to explain a physical status modifier or a qualifying circumstance and then you might be able to be expected to add additional diagnosis codes.

All this is is telling a story to the insurance company. And for the most part, one or two ICD 9, later ICD 10 diagnosis codes, should be enough. The majority of them should just require one.

This comes from your general medical coding guidelines Sections 4 and 5 under Sub-category B.

Appendectomy, appendicitis

Don't rely on just because it's the type of surgery they're having you don't need the diagnosis documented. You still need it documented.

Some of the underdocumented codes that we've seen quite a bit in the past years are cataracts and that's because often you don't give enough information to assign anything past that 366.9 unless you go digging deeper into the medical record which anesthesia coders don't always have access to that coding and compliance information.

So this is more an opportunity to educate your practitioners as to what they need to provide you.

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