Coding General Anesthesia Provided by CRNA
Dawn Seelye, RHIA
Preoperative Diagnosis: Degenerative medial meniscus tear, right knee with chronic synovitis
Type of Anesthesia: General
Anesthesia Provider: Certified registered nurse anesthetist (CRNA)
Under satisfactory endotracheal general anesthesia, the patient was placed supine on the operating table. The right leg was placed in a well-padded, thigh-holding device flexing the hip 20 degrees. A pneumatic tourniquet was applied at 300 mm Hg but not inflated. A routine 10-minute Betadine scrub followed by prep and sterile draping of the extremity was carried out. The knee was then examined and appeared stable.
The skin and subcutaneous tissue were infiltrated with 0.25 percent Marcaine and epinephrine after which a patellar tendon-splitting incision was made through a transpatellar tendon approach. A 25-degree Wolf arthroscope was introduced in the suprapatellar pouch, after successive insertion of a blunt cannula and trocar. A medial irrigation portal was established with satisfactory flow. An accessory anteromedial portal was then made.
The right knee was examined and appeared to be stable. The patella had some Grade II changes in the medial femoral condyle. The lateral femoral condyle, tibial plateau and meniscus were normal. The medial femoral condyle had some Grade III changes. The medial meniscus had a complex posterior horn tear. The tibia appeared to be satisfactory.
Using basket forceps and a motorized shaver, a subtotal medial meniscectomy was carried out. A generous chondroplasty and a very limited medial synovectomy of the femoral condyle were performed. The joint was thoroughly irrigated, infiltrated with Marcaine, and a sterile dressing was applied.
The patient tolerated the procedure well and was transferred to the recovery room in satisfactory condition. The neurovascular status of her extremity was normal.
Postoperative Diagnoses: 1) Degenerative posterior horn medial meniscal tear, right knee; 2) Grade III chondromalacia of the medial femoral condyle; 3) Nonspecific medial synovitis; 4) Grade II chondromalacia of the patella
CPT Code Assignments
First determine the type of anesthesia provided and who provided it. In the case above, the answers are general anesthesia administered by a CRNA.
For a Medicare claim, one anesthesia code but no surgical code would be assigned. For most other payer claims, one primary or principle surgical code but no anesthesia code would be assigned. When choosing a CPT code, it is best to assign one for the surgical service, then crosswalk to the appropriate anesthesia code.
To do so, look in the CPT manual index under Arthroscopy, Surgical, Knee. The code range listed is 29871-29889. For the surgical component for this case, codes 29877 and 29881 would be assigned. All of the correct surgical codes must be assigned first to ensure that you submit the anesthesia CPT code with the highest BVU (basic value unit) or RVU (relative value unit for the surgical code).
For a non-Medicare payer, we would choose the CPT procedure code with the highest RVU. (This can be obtained through the physician’s fee schedule, which the Health Care Financing Administration prints every year.)
For non-Medicare payers, CPT code 29877 would be assigned. Modifier QZ would be appended to the code to reflect that a non-medically directed CRNA provided the anesthesia service without an anesthesiologist present.
29877-QZ Arthroscopy, knee, surgical;
debridement/shaving of articular cartilage
If you were submitting a claim for a Medicare patient, look up the CPT surgical codes 29877 and 29881 and crosswalk them to the appropriate CPT anesthesia code(s). Both codes 29877 and 29881 crosswalk to code 01382. Note that if these two codes crosswalked to different CPT anesthesia codes, you would want to choose the CPT code with the highest BVU. (This information can be obtained from the American Society of Anesthesiologists). Assign code 01382 once and also attach modifier -QZ for the same reason described above.
01382-QZ Anesthesia for arthroscopic procedures of knee joint
ICD-9-CM Code Assignments
In the case study above, the code assigned for the preoperative diagnosis will be different than that which will be assigned for the postoperative diagnosis. The following two codes are assigned as the preoperative assignments.
717.3 Other and
unspecified derangement of medial meniscus
727.0 Synovitis and tenosynovitis, unspecified
Four ICD-9-CM codes would be assigned for the postoperative diagnoses.
717.2 Derangement of posterior horn of medial meniscus
727.00 Synovitis and tenosynovitis, unspecified
717.7 Chondromalacia of patella *
Dawn Seelye is a senior health care consultant with Medical Learning Inc. (MedLearn), St. Paul, MN.