Understanding Hypothermic Circulatory Arrest and Correct Cardiac Anesthesia Code Selection
Don’t Leave Base Units on the Table
Cardiac anesthesia coding is one of the most specialized areas of anesthesia coding, and one of the most common opportunities identified during audits is the undercoding of ASA 00563.
Many coders automatically assign ASA 00562 whenever cardiopulmonary bypass (pump oxygenator) is documented. However, not every cardiac procedure performed with cardiopulmonary bypass is coded the same. One of the most important distinctions is whether hypothermic circulatory arrest (HCA) was performed.
Just as importantly, the anesthesia record should also support this service. The anesthesia record frequently documents systemic cooling, the period of circulatory arrest, target temperature, cerebral perfusion techniques, and other details that confirm the use of hypothermic circulatory arrest. Reviewing both the operative report and the anesthesia record helps ensure accurate ASA code selection.
Understanding the Difference
ASA 00561 – Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age.
ASA 00562 – Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, age 1 year or older, for all noncoronary bypass procedures (e.g., valve procedures) or for re-operation for coronary bypass more than 1 month after original operation.
ASA 00563 – Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator with hypothermic circulatory arrest.
Why Is ASA 00563 Commonly Undercoded?
Many coders stop reading once they identify documentation of cardiopulmonary bypass (pump oxygenator) and immediately assign ASA 00562. Unfortunately, this can result in missed reimbursement when documentation later confirms that hypothermic circulatory arrest was performed.
Always continue reviewing both the operative report and the anesthesia record before assigning the anesthesia code.
Documentation Clues to Look For
Operative Report
- Hypothermic circulatory arrest (HCA)
- Deep hypothermic circulatory arrest (DHCA)
- Systemic cooling
- Total circulatory arrest
- Antegrade cerebral perfusion
- Retrograde cerebral perfusion
- Aortic arch reconstruction
- Hemiarch replacement
- Ascending aortic replacement
- Complex thoracic aortic repair
Anesthesia Record
- Initiation of cardiopulmonary bypass
- Cooling to target temperature
- Hypothermic/deep hypothermic circulatory arrest
- Duration of circulatory arrest
- Antegrade or retrograde cerebral perfusion
- Rewarming following circulatory arrest
- Perfusion events documented by the anesthesia team
Coding Tip: Always compare the anesthesia record with the surgeon’s operative report. The anesthesia record often provides additional evidence that hypothermic circulatory arrest occurred.
Coding Example
Procedure Performed:
- Ascending aortic aneurysm repair
- Hemiarch replacement
- Cardiopulmonary bypass
- Deep hypothermic circulatory arrest
- Antegrade cerebral perfusion
Incorrect Coding: ASA 00562
Correct Coding: ASA 00563
Why? The documentation clearly supports the use of deep hypothermic circulatory arrest, which is specifically described by ASA 00563.
Auditor’s Tip
Don’t stop reading after identifying cardiopulmonary bypass. Review both the operative report and the anesthesia record for hypothermic circulatory arrest, cerebral perfusion, systemic cooling and rewarming, duration of circulatory arrest, and complex aortic reconstruction before assigning the anesthesia code.
The surgeon tells you what was repaired. The anesthesia record tells you how the patient was managed. Reviewing both records is essential to distinguish ASA 00562 from ASA 00563 and ensure accurate cardiac anesthesia coding.
Have you encountered cases where 00563 was missed? Share your experiences or questions in the comments. I’d love to continue the conversation.
Leave a comment