PopQuiz: Anesthesia Coding for Baker's Cyst

[Ruth Sheets]

Sara, a healthy patient, age 32, is having an excision of a Baker's Cyst located on the back of the knee. MAC is being performed by a CRNA under the medical direction of an anesthesiologist who is simultaneously medically directing three other cases. The CRNA begins preparation of the patient at 10:35 am, actual anesthesia is applied at 10:45 am and continues until 11:20 am. The CRNA is no longer needed at 11:25 and leaves for her next patient. The time units are in 15 minute units. What are the CPT codes and ICD codes for the anesthesiologist, the CRNA, and how much actual time is reported, and how many full units of time?

See next post for the answer and rationale.

 

[Ruth Sheets]

Rationale: Looking at the Anesthesia codes for the Knee and Popliteal Area, there are no specific codes for excision of a Baker's cyst. It is an open procedure of the knee joint, so code 01400 is correct. For the anesthesiologist we need to append modifier QK to indicate that he/she was medically directing 2 to 4 concurrent anesthesia procedures by qualified individuals. The qualified individual, namely the CRNA, would need to append QX. Both the anesthesiologist and the CRNA would append QS to indicate it was monitored anesthesia care. Both would append P1 to indicate the normal healthy patient physical status. The time reported starts when the CRNA begins preparation of the patient and ends when the CRNA is no longer needed, that is, from 10:35 am to 11:25, or 50 minutes. Three 15 minute units of time were completed.

So the answer would be:
Anesthesiologist: 01400-QK-QS-P1
CRNA: 01400-QX-QS-P1
Time reported: 50 minutes
Time units: 3

 

[Carolyn Heath]

Ruth, do you add the time reported and tine units when you are coding for an anesthesiologist? I was told that you do not. Please clarify. Thanks!

 

[Ruth Sheets]

Interesting that you were told not to report the time units.
The Anesthesia Guidelines under Time Reporting says:
Time for anesthesia procedures may be reported as is customary in the local area. Anesthesia time begins when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room (or in an equivalent area) and ends when the anesthesiologist is no longer in personal attendance, that is , when the patient may be safely placed under postoperative supervision.

It seems to me that in general, the time for the anesthesiologist is reported, but perhaps your payer doesn't need it?
I'm going to ask Alicia to comment, and/ or others who may know more than I do on this!

 

[Alicia Scott]

For the CPC exam you will need to know the time that is reported but for the exam it is not done like you would fill out a CMS1500 form or anesthesia reports.

 

[Carolyn Heath]

Thanks! I just got my 2013 CPT book and I will highlight that section about Time Reporting. Do you know anything else that I should hightlight? I already know that you should highlight the parentheticals.

 

[Alicia Scott]

I would also make sure the add on codes are easy to see. 99100 etc which are listed in the guidelines.

 

[Carolyn Heath]

Thanks, Alicia!