Medical Coding Guidelines for Anesthesia Diagnosis Coding

ICD-9 coding is a significant element to your anesthesia claims -- but it's an often misunderstood process when it comes to general coding and claims processing. Let us look at some of the medical coding rules and guidelines you must know in order to ensure accurate diagnosis coding

Let’s talk about the history code guidelines under Chapter 18-A. And regardless of which diagnosis coding book you have chosen, the medical coding conventions are going to remain the same. So hopefully in your history code guidelines under Chapter 18-A, you will have a Section 3 that indicates circumstances of problems that influence a person's health status but are not in themselves a current illness or injury are not coded as current illness or injury.

That's where your proof in the pudding come from for that not doing this on a routine basis because your patients may often have personal histories of heart problems or their status post-CABG, that they're having an anesthesia service for maybe a colonoscopy or a cataract or an appendectomy that has absolutely nothing to do with the CABG but the CABG is - the history of the CABG is going to support maybe the patient's physical status.

Our expert said in a diagnosis healthcare event that another big one is a neoplasm. You cannot - coders cannot confuse the term “mass” or neo - or “lesion” with the term “neoplasm”. They don't mean the same thing. Neoplasm is literally new growth if you go back to your terminology roots but does not necessarily the same coding-wise as a mass or lesion.

If you go to Section 239 of your ICD-9, you will see under the “Neoplasms of Unspecified Nature” – and this is in quotation marks because it should be exactly the same no matter which book you have – the term “mass”, unless otherwise stated, is not to be regarded as a neoplastic growth.

And they go further to tell you that you need to look at disease of specified organ or site. And the one that comes to mind for me is pancreas. There is no term under mass for pancreas so you have to go to disease of specified organ or site, go to pancreas and that's the code assignment.

If you go to Chapter 2 of your neoplasms under the general medical coding guidelines, they also tell you you should reference the term “lesion” first. So often, rather than going to the neoplasm title - tables for the joint or skin lesions, you're going to go under lesions.

Postoperative pain is just a little bit more confusing. The information from the medical coding guidelines, even if they're not in your book are obtainable on the CMS website or if you have different types of coding programs. You can still pull these rules other than just relying on your book.

But here we want to share you a little bit of a conflict with the post-op pain because according to the official guidelines for medical coding and reporting post-op pain, several years ago they added ICD-9 codes 338.1 and 338.2 depending on whether the pain was acute which is like a rapid onset or a short-term pain or chronic which is more associated with perhaps pain management.

It says, “If pain control is the reason for the surgery, a category 338 code should be reported as the principal diagnosis.” So that is the coding convention. That should be your primary code.
But there is a a contradiction, “Postoperative pain may be reported as the principal or first listed when it's the reason for post-op pain management.” And in several sentences down it says, “Routine or expected postoperative pain immediately after surgery should not be coded.”

That is a contradiction in terms that most of the postoperative pain for perhaps total shoulders, total knees, hysterectomies are that the surgeon is paid in their global to handle the patient's routine or expected postoperative pain.

But often this goes beyond the capability of the surgeon and they will ask an anesthesiologist or an anesthesia provider to help them manage that expected postoperative pain.

If you're providing these services and you're not appending the 338, are you getting denials? So this is what you need to pay attention to in your practice.

It is a billable and payable service as per medical coding rules. Those 338's are to help the insurance companies understand how often the surgeons are passing this responsibility for post-op pain management to these anesthesia providers. So they should be reported.

Medical Coding Training Tip: Tou look at your own practice and see that if reporting them is causing denials, you need to check with your insurance company. And if not reporting them is causing denials, again, you need to check with your specific insurance company.

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