When anesthesia practices ask about sources of lost revenue, the first thing I mention is something which they have complete control over: clinical charting. Did you know that there are over 700 surgical descriptors that can ‘crosswalk’ to higher base units than their primary option? The secret to being eligible for these higher case payments is documentation, combined with an understanding of which service lines are impacted. This goal of this article is to share this information, so that you can disseminate to your clinical colleagues. While I’ve covered commonly-known examples in past articles (i.e., surgical arthroscopy, 3-level laminectomy/laminotomy/disc replacement, spinal fusions with instrumentation, one-lung vent, and AICD with active testing), this piece will focus on some of the more obscure clinical vignettes. The list below is not all-encompassing, but it certainly hits the high points.
1. Integumentary procedures
Any skin procedure of the head, neck, or posterior trunk is automatically valued at 5 base units (ASA 00300), so make sure that your procedural description notes the anatomical location. Failure to do so may result in underpayments, as the primary crosswalk option is only valued at 3 base units (ASA 00400). In other words, ‘lesion removal’ alone is never sufficient. There are over 90 surgeries where this applies.
2. Cervical Spine and Intracranial procedures in the Sitting Position
There are over 40 examples of surgeries where surgical positioning of ‘sitting position’ yields higher base units. Be sure to do two things on this front: document appropriately and perform spot audits of your biller, to ensure that no revenue is left on the table. The cervical spine ASA code involved is 00600 (10 base), vs. sitting position code 00604 (13 base). The intracranial codes in play are 00210 (11 base) and 00211 (10 base), vs. sitting position code 00218 (13 base).
3. Symphysis Pubis/SI Joint procedures
There are 13 surgery types where charting approach (open) and anatomical location (Symphysis Pubis or SI Joint) can generate additional revenue for your group. The primary crosswalk codes are valued at 3-6 base units, while the Symphysis Pubis / SI joint code is valued at 8 (01170).
4. Femoral Bone Surgery (Open)
Another example of charting for orthopedic anesthesia involves the Femur. Did you know that there are 18 different surgeries where approach (open) and femoral location matters? From a coding perspective, the Femur is divided into the upper two-thirds and lower one-third, though few anesthesia providers are accustomed to charting to this level of granularity. It’s important, because not doing so may end up as an underpaid case. The primary crosswalk codes are valued at 3-5 base units, while the more precise codes (01360 – open, lower one-third and 01230 – open, upper two-thirds) are valued at 5 and 6 base units, respectively. Best practice is to specify surgical approach and anatomical location for all such cases.
5. Bone Marrow Aspiration/Biopsy of Iliac Crest
Similar to the items referenced above, charting surgical location is crucial for accurate payment. For all Bone Marrow Aspirations or Biopsies, remember to specify the Iliac Crest, when appropriate. There are 33 surgical procedures where this applies. Primary crosswalk options are valued at 3-4 base units, while the Bone Marrow Aspiration/Biopsy of the Iliac Crest code is valued at 5 base units (01112).
6. Hernia, Larynx, and Trachea Peds’ cases
Were you aware that there are over 90 surgeries for this service line where patient age has an impact on payment? Billers and coders should always consider this fact, prior to submitting a claim on your behalf. The primary crosswalk codes are valued at 6 base units, compared to age-specific code 00326 (8 base units). With the elimination of payment for extreme age code 99100 (under age 1 or over age 70) by many insurers, using this code is the only way to be compensated for the increased risk involved. There are also seven Hernia procedures which allow more than the traditional 4 base units, if the patient is younger than age 1 (00834 – 5 base) or < 37 weeks gestational age at birth and < 50 weeks gestational age at time of surgery (00836 – 6 base).
7. Upper vs. Lower Abdomen
This is one of the top reasons for pended cases by billers, as charting rarely specifies whether the surgical procedure (and not the approach) is above or below the umbilicus. It’s a big deal, as there are nearly 80 surgical procedures where this level of documentation is required for coding. While some procedures are self-evident, others can involve either the upper or lower abdomen, or both. What’s interesting is that the default primary crosswalk code for many intraperitoneal abdominal procedures is ‘lower’ (00840 – 6 base), so coders need to ask for clarification if location isn’t specified. The upper abdominal peritoneal code allows an additional unit per case (00790 – 7 base).
Free Charting Training from MSN Healthcare Solutions
In conclusion, it’s best not to have your biller pulling operative reports to verify these surgical nuances. Doing so will simply increase your Days in AR and decrease your Collections. Best practice is to ask your clinicians to chart appropriately on the front end. If you’re not currently an MSN billing client and would like to preview the ‘MSN difference’, please click here to register for a free charting training session. There’s no obligation; just information sharing to help your practice thrive.
Hal has 30+ years of experience on both the payor and RCM side, with a focus in Anesthesia. He formerly worked as a senior claims approver at United Healthcare, as well as a compliance officer for multiple national anesthesia billing companies. His broad-based experience ensures that MSN clients have a resource for documentation and billing issues. His past speaking engagements include ASA, MGMA, Dartmouth, and Johns Hopkins.
