Revenue Cycle Insider

Question: A patient had surgery for cataract extraction and required monitored anesthesia care via a sedative, alongside conjunction with a peribulbar and retrobulbar injection as a regional block. According to the surgery notes, there was an interval of 32 minutes where the patient didn’t require monitoring by the anesthesiologist, but then the anesthesiologist needed to monitor the patient during the cataract extraction. Can I bill for the anesthesiologist’s services for that interval time, and also the recovery time?

Massachusetts Subscriber

Answer: No, according to the National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services: “The time that may be reported would include the time for the monitoring during the block and during the procedure. The interval time and the recovery time are not included in the anesthesia time calculation.” Additionally, if “unusual services” are provided during this time that aren’t part of the bundled care for anesthesia before the beginning of or after the anesthesia care, they may or may not be included as reportable anesthesia time.

If there is supporting documentation that continuous monitoring by an anesthesiologist is medically necessary, then CMS may pay for the time. Check with the respective payer if you’re billing a commercial carrier to make sure you’re following their guidelines.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC