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Summer 2006


Coding Corner: Important Role Of CPT Surgical Codes

Jody Locke, Vice President
Anesthesia Business Consultants, LLC

Many anesthesiologists believe that the ASA codes developed by the American Society of Anesthesiologists in the 1970s are the only codes they need to know in order to bill appropriately for the services they perform. Even though it is true that more than 75% of insurance claims for anesthesia charges are now submitted using ASA codes, it would be a very serious mistake to ignore the important role CPT surgical codes continue to play in correct coding. Certified coders understand that the only accurate way to determine the appropriate ASA code is via the ASA Cross-Walk. They understand that you can go from the specific to the general, but not the other way around. Ignoring the Cross-Walk can lead to significant under- and over billing. The following are just a few examples of the subtle interplay between the procedure-specific CPT codes and the more generalized ASA codes. Each example highlights the kind of confusion that can be created by referring only to the ASA Relative Value Guide.

Consider an inguinal hernia repair. The typical inguinal hernia is coded with CPT code 49505, which crosswalks to ASA code 00830 with a basic value of 4 units. A laparoscopic hernia repair, by contrast, should be coded with CPT code 49650, which corresponds to ASA code 00840 with a basic value of 6 units. Our experience is that an inexperienced coder or a physician coding only from the ASA Relative Value Guide would miss the subtle distinction more often than he or she would catch it and lose 2 billable units each time as a result.

p>Another very common area of confusion relates to the distinction between the two most common codes for abdominal procedures, ASA code 00790 with a base value of 7 units and ASA code 00840 worth 6. Because much of the large intestine lies in the lower abdomen there is a tendency to code any procedure on the cecum or large intestine with code 00840, but this would be a costly mistake. A sigmoid resection is properly coded with CPT code 44141, which is mapped to ASA code 00790 in the ASA Cross-walk. If the only point of reference were the ASA guide the result would be a loss of one billable unit per procedure.

Sometimes the confusion is related to a slightly different aspect of coding. When there are multiple code options, as occurs when multiple surgical procedures are performed during a case correct coding guidelines involve picking the code with the highest relative value. To code a case involving an EGD and a bronchoscopy the coder must consider the code for the EGD (43235) and the code for the bronchoscopy (31622). Since the first corresponds to ASA code 00740 with a base of 5 units and the second to code 00520 with a base of 6 units, the correct code for the case is 00520 and not 00740 even though it might seem that the EGD is the more significant component of the service.

These are just a few examples of the many discrepancies routinely identified by the ABC coding department when client physicians do their own coding based exclusively on the ASA Relative Value Guide. As the old saying goes, anyone that believes anesthesia billing is easy is either a terrible biller or a terrible liar. If you want optimum results let professionals make appropriate determinations using appropriate tools.