Anesthesia Coding Alert

For many specialties, coding and billing office visits and consultations are routine. For an anesthesiology practice, the fees for the same or similar E/M services are often bundled with the overall procedure or included in a global period, making coding a bit more complicated. The majority of surgical procedures listed in CPT include a global period the time before, during, and a specific number of days after the procedure that is part of the primary surgical fee. Therefore, anesthesiologists cannot regularly charge separately for the preoperative evaluation, anesthesia during surgery, or the follow-up visit. But, dont lose hope there are times when anesthesia providers can charge separately for these services. Asking the right questions in the right order can get you on the correct coding path.

Is Service Included in Global Period?

Some anesthesiology procedures (which are starred) have zero global days, so anesthesiologists can bill separately for them. CPT says, Certain relatively small surgical services involve readily identifiable surgical procedures but include variable preoperative and postoperative services (i.e., incision and drainage of an abscess, injection of a tendon sheath, manipulation of a joint under anesthesia, dilation of a urethra). Because of the indefinite pre- and postoperative services, the usual package concept for surgical services cannot be applied.

Anesthesiologists can also bill separately for non-starred procedures that have no global period (zero global days), including injections and other pain-management procedures. This is because theyre not services that are within the global anesthesia fee of a consultation or outpatient visit. For example, an epidural steroid block (62311) has zero global days, so it can be billed as a separate procedure along with the appropriate-level consultation or outpatient visit code. The E/M code should be appended with modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to indicate the E/M was separate from the block.

Is It an Outpatient Visit or a Consultation?

Before coding a visit, youll need to determine whether the time with the patient is an office visit or a consult, and that depends on the way the primary care or other physician refers the patient. If the referring physician requests the anesthesiologist to evaluate and treat a patient, the patients care is now in the hands of the anesthesiologist. This is an office visit. If a physician asks the anesthesiologist to render an opinion or give advice about the patients condition, its a consultation. Following are examples of both:

Outpatient Visit: An orthopedic surgeon refers a patient with low back pain to an anesthesiologist. Because other pain management is not an option, the surgeon thinks an epidural might help the patient. The anesthesiologist examines the patient, [...]