Sometimes You Can Bill for Anesthesiologist’s Time Despite Canceled Surgery
Question: I’m newer to anesthesia coding and need help with a canceled case. The surgery notes say a 68-year-old patient was scheduled for an exploratory laparotomy for a suspected small bowel obstruction. The anesthesiologist began preparing the patient in the operating room at 08:05, induced general anesthesia, intubated the patient, and remained in continuous attendance. After the abdomen was entered, the surgeon discovered diffuse metastatic disease and determined that the planned procedure should not proceed. The operation was terminated, and the patient was taken to the post-anesthesia care unit (PACU). The anesthesia record shows the anesthesiologist transferred care to PACU staff at 09:02. Can we still bill anesthesia time even though the surgery was canceled? If so, how much? Minnesota Subscriber Answer: The fact that the surgical procedure was terminated does not automatically eliminate the anesthesia service. Report the anesthesia code that corresponds to the intended surgical procedure and bill the actual anesthesia time documented through the time at which the anesthesiologist was no longer furnishing anesthesia care. In this scenario, anesthesia time began at 08:05, when the anesthesiologist started preparing the patient for anesthesia in the operating room, and ended at 09:02, when the patient was safely placed under postoperative supervision. That results in 57 minutes of billable anesthesia time. The key is that anesthesia time is not limited to the period during which the surgeon is actively operating — anesthesia time continues until the anesthesia practitioner is no longer in personal attendance and the patient may be safely placed under postoperative care. The Centers for Medicare & Medicaid Services (CMS) defines anesthesia time as beginning when the anesthesia practitioner starts preparing the patient for anesthesia and ending when the practitioner is no longer furnishing anesthesia services and the patient may be safely placed under postoperative care. CPT® anesthesia guidelines similarly state that anesthesia time ends when the anesthesiologist is no longer in personal attendance and the patient may be safely placed under postoperative supervision. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
