Be Cautious Before Reporting Neonatal Hypothermia During Heart Procedures

Latest CCI edits have a say on hypothermia

In case your anesthesiologist carries out controlled hypothermia in neonatal heart surgery cases, you must only report the anesthesia code, and never the "T" code as far as hypothermia is concerned. The latest Correct Coding Initiative (CCI) edits brought changes in the hypothermia(plus edits related to injection procedures). Read on this expert anesthesia coding and billing advice for cleaner claims.

Anesthesia Outweighs Hypothermia

Every single edit pair linked to anesthesia concentrates on codes 0260T (Total body systemic hypothermia, per day, in the neonate 28 days of age or younger) as well as 0261T (Selective head hypothermia, per day, in the neonate 28 days of age or younger).

The edits associated with 0260T and 0261T use the description "Misuse of column two code with column one code." CCI 17.2 specifies that you should not report neonatal hypothermia codes using the cardiac anesthesia codes:

00560 -– i.e. Anesthesia used for procedures on heart, pericardial sac, as well as great vessels of chest; excluding pump oxygenator

00561 -- i.e Anesthesia used for procedures on heart, pericardial sac, as well as great vessels of chest; including pump oxygenator, younger than 1 year of age

00562 -- i.e Anesthesia used for procedures on heart, pericardial sac, as well as great vessels of chest; including pump oxygenator, age 1 year or older, meant for all non-coronary bypass procedures (for instance., valve procedures) or for re-operation for coronary bypass more than 1 month following original operation

00563 -- i.e Anesthesia used for procedures on heart, pericardial sac, as well as great vessels of chest; including pump oxygenator by means of hypothermic circulatory arrest

00566 -- i.e Anesthesia used for direct coronary artery bypass grafting; excluding pump oxygenator

00567 -- i.e Anesthesia used for direct coronary artery bypass grafting; including pump oxygenator

00580 -- i.e Anesthesia used for heart transplant or heart/lung transplant.

Note: CPT® consists of a qualifying circumstances code you can occasionally report once your anesthesiologist treats patients of extreme age: +99100 (Anesthesia for patient of extreme age, younger than 1 year and older than 70 [List separately in addition to code for primary anesthesia procedure]). For anesthesia coding, never use +99100 in combination with codes that specify patient ages, though, such as 00561.

Caution: Cardiac anesthesia codes that are not age specific and do not specify that the service involves hypothermia might be qualified for circumstances codes.

Plus: Each of the hypothermia edits has a modifier indicator of 1, implying you can use a modifier to isolate these bundles when both services were medically essential and conducted as separate procedures. Look out for notations in the patient record maintaining that anesthesia was complex by utilization of total body hypothermia or a description of the procedure used to lower the patient's body temperature lower than 35C/95F.

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