Deemed rather mysterious and spooky, anesthesiology is the study and practice of administering sedation or anesthesia to a living creature in order to block pain. For a coder, anesthesiology coding throws open many a tough challenge.

The situation: An anesthesiology client works in an eye center. Fairly new, he says that he does all blocks and no general anesthesia for the eye surgeries. What should he use - A code from range 00140-00148 or a code such as 64400?

If you deem your anesthesiologist is acting as the anesthetist for the eye surgery and is not the provider performing the actual eye surgery, and that his primary anesthesia method for every eye procedures is a bulbar block instead of general anesthesia to anesthetize his patients, then the main anesthesia technique is a block.

If your anesthesiologist does only the block, then he is providing a surgical service:

a) 64400 (injection, anesthetic agent; trigeminal nerve, any division or branch) or
b) 67500 (Retrobulbar injection; medication (separate procedure, does not include supply of medication)

Whereas if he does both the block and anesthesia, he can bill the time for the block and all the time plus base value for the procedure 00142 (Anesthesia for procedures on eye; lens surgery) if the surgery happens to be for a cataract.

The American Society of Anesthesiologist (ASA) code assigned to the actual anesthesia service depends on the type of procedure being executed. For instance, a cataract extraction would be coded by CPT as 66984 and crosswalk to ASA 00142.

Don’t let these anesthesia coding challenges bog you down. There is a 2010 Anesthesia Coding Update and Reimbursement Conference happening in Orlando, FL on December 6-8, 2009. Don’t miss this chance to update yourself on the latest 2010 coding changes for your specialty.