Chart Talk ~ Anesthesia Coding Conversations

Another week of anesthesia coding is behind us.  Maybe it was a great week. Maybe it was one of those weeks when every record seemed to bring another question.

You may have encountered a procedure you had never coded before. You may have struggled with the anatomy of a nerve block. Maybe the documentation did not clearly support the service you expected to code. Perhaps you questioned an anesthesia code selection, disagreed with guidance, spent far too long researching a single case, or discovered that something you thought you understood was more complicated than you realized. That’s anesthesia coding, and before we carry the entire week into Monday morning with us, perhaps we should ask ourselves two questions: What should we take with us and What can we leave behind?

Every difficult case teaches us something. Sometimes the lesson is a new coding rule, sometimes it is anatomy, sometimes it is learning where to find authoritative guidance, and sometimes the lesson has nothing to do with a code at all. It may be learning when to ask another question, when to research further, when to respectfully challenge an answer, or when to admit: “I don’t know yet.”  Notice that last word—yet.  There is an enormous difference between I don’t know this and I can’t learn this. Take the lesson into next week. Leave the expectation that you should already know everything behind.

There are going to be cases that frustrate you. You may spend thirty minutes researching something that ultimately looks simple once you understand it. You may receive conflicting information, you may discover that a coding decision you made earlier could have been better, you may even have a moment when you wonder: “Why can’t I understand this?” Leave that question behind and replace it with: “What am I missing that will help me understand this?” That small change turns frustration into investigation and investigation is something good coders know how to do.

We sometimes need to remind ourselves that anesthesia coding involves much more than choosing an anesthesia CPT code. We are navigating surgical anatomy, anesthesia anatomy, CPT and ASA code selection, anesthesia time, medical direction and supervision, physical status modifiers, qualifying circumstances, postoperative pain management, peripheral nerve and fascial plane blocks, invasive lines and ancillary procedures, TEE and ultrasound guidance, documentation requirements, NCCI edits, Medicare guidance, payer-specific policies, medical necessity, and compliance.

And sometimes all of those things can appear in one anesthesia record. So why would we expect ourselves to know every answer immediately? Being an experienced anesthesia coder does not mean you never encounter something you don’t understand.

Experience teaches you what to do when you don’t understand it. You research, you ask questions, you verify, you compare the documentation to the guidance, you learn the anatomy, you go back to the source and then you add another piece of knowledge to your toolbox.

There will always be another challenging topic. Maybe right now it is medical direction, nerve blocks, anesthesia for spine procedures, obstetric anesthesia, TEE, invasive monitoring, anesthesia time, or determining exactly where a nerve was approached. Whatever your difficult topic happens to be, don’t allow one area you haven’t mastered yet to convince you that you don’t belong in anesthesia coding.

Think about something that once confused you but now feels routine. There was probably a time when you had to stop and look it up. That’s how expertise develops. Not by knowing everything on day one, but by continuing to learn on day two, day three, and year ten.

Maybe you are wondering what you should take into next week. Take your curiosity, the resources you discovered, the notes you made, the questions you still need answered, and the lesson from the mistake you caught. Take the confidence you gained from the difficult case you finally figured out, your willingness to say, “Show me the source”, your commitment to accurate, compliant coding, and most importantly, take your willingness to keep learning.

Leave behind the frustration from the case that took too long, the embarrassment of asking a question, and the expectation that experienced coders should know everything. Leave behind the comparison to someone who has been coding anesthesia longer than you, the one mistake you already learned from, and leave behind the voice telling you: “Maybe I’m just not good at this.” You don’t need any of those things next week.

When you open that first anesthesia record next week, there will probably be something new waiting for you. Good. That’s another opportunity to become a stronger coder. Anesthesia is complex. That’s one of the things that makes this specialty so interesting. We aren’t going to understand every procedure, every anatomical approach, every payer rule, or every unusual anesthesia scenario the first time we encounter it, but we can learn it one record, one question, one guideline, one piece of anatomy, one week at a time.

Before Monday, identify: One thing you learned last week that you’re taking with you. Then identify: One frustration you’re choosing to leave behind. Write both down, take the lesson, leave the weight, and start the new week ready to learn again.

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