Anesthesia Coding Alert

Its a rather common scenario for anesthesia coders a case is canceled or postponed, and the physician wonders how to get paid for his or her part in the procedure. Your best option for handling the situation may depend on what the carrier dictates, but it also may depend on how far along the procedure was when it was cancelled.

Before attempting to file for reimbursement, you should know why the case was canceled or postponed, says LaSeille Willard, CPC, who codes for Anesthesia Consultants, P.A., a 20-physician group in Thurmont, Md. There are lots of different reasons that cases are canceled, she says. The patient may have scheduled an elective procedure that he or she decides not to have. The patient may still want to have the procedure but decides to postpone it because he or she wants to meet the deductible first, or for some other reason. Or a sudden medical complication may mean that canceling the procedure is in the patients best interest.

Whatever the reason, it should be documented clearly on the patients chart. The point at which it was canceled is also key to reimbursement. Any involvement by the anesthesia team prior to cancellation must be apparent before any reimbursement can be sought.

Canceled Prior to Induction

When surgery is postponed before the induction of anesthesia, most carriers say, any preprocedure work that has been completed is included with the pre-op evaluation when the case was scheduled originally. Many hospitals conduct pre-op screening on the patient one or two weeks before surgery. The fee for this pre-op evaluation is included in the start-up charge for the anesthesia procedure. If this is the case, the anesthesiologist may not be able to bill for care on the actual day of the surgery but can use this evaluation as part of the preoperative evaluation when the surgery is rescheduled.

Some anesthesia providers will review the pre-op work in this situation and bill the appropriate evaluation and management (E/M) code. Suggested codes to use include 99212-99215 for established outpatients and 99231-99233 for inpatients along with modifier -53 (discontinued procedure) to indicate the procedure was canceled. Some carriers may accept consultation codes 99241-99245 for outpatients and 99251-99255 for inpatients with modifier -53. When the surgeon schedules the surgery for general anesthesia, he or she automatically requests an anesthesiologist. The anesthesiologist provides a report on the patients pre-op physical and the review of records and medical history, which can qualify as a consultation.

The physicians Willard codes for do not seek reimbursement if a case is canceled before it starts. She does believe that the pre-op consult could be billed at the appropriate level, assuming there is adequate [...]