While coding for anesthesia during an abdominal procedure, it is important that you determine whether the surgeon worked in the upper or lower abdomen. Read on for our experts’ advice on how to know which area you should report.
Background: Every anesthesia code is associated with multiple surgical procedures that can be performed in that anatomic area. CPT® includes 14 codes for upper abdominal anesthesia and 25 codes for lower abdominal anesthesia. Two prime examples that can confuse coders are:
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- 00790— Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified
- 00840—Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified.
Learn the Opinions on ‘Dividing Line’
“Knowing the ‘dividing line’ between upper and lower is an ongoing topic of discussion in our office,” says Pam Stopher, CPC, ACS-AN, with Park Medical Management, Inc., in Memphis, Tenn.
“I always wondered how to handle these situations, until we asked an auditor who did an internal audit of our work,” adds Shelley Hamm, RHIT, coding specialist with Professional Solutions Stat in Saint Louis, Mo.
Common opinions can include:
- Where the physician spends the most time during surgery
- The surgical location in relation to the umbilicus (anything above the umbilicus is upper abdomen, anything below is the lower abdomen)
- The point of incision (above or below the umbilicus).
Caution: Although the point of incision can point you toward the correct upper/lower answer, that isn’t always the case. Instead, focus on where the procedure is performed more than the incision point.
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