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 documentation to support the consults level and it does not serve as a preoperative anesthesia exam. Many practices will not try to bill for the consult if the surgery is postponed only for a week or so. They will bill for the initial consult if the surgery is rescheduled for a date that is far enough in the future to merit conducting another complete pre-op consult.

And After

Tracey Dellinger, office manager for Midatlantic Anesthesia, an anesthesia group of eight doctors and two CRNAs in Emmitsburg, Md., says that most carriers will pay for the anesthesia service if the surgery is canceled after the induction of general or regional anesthesia. Two options for billing in this situation are:

1. Report using the anesthesia unlisted procedure code 01999 (unlisted anesthesia procedure[s]), which has a value of three base units plus time units. The claim must include a description of the proposed surgery, an explanation of why the surgery was canceled and a copy of the anesthesia record. Dellinger warns that some carriers may balk at reimbursing for this code, even with all the documentation. The policy for reimbursing for 01999 can also vary from one Medicare carrier to the next, so be sure to check your local guidelines or speak with the carrier to see how they prefer to handle the situation.

2. Report using the procedure code with modifier -53 (discontinued procedure). For example, the patient may be prepped and induced by the anesthesiologist and waiting for the surgeon to arrive. Prior to incision, the patients vital signs indicate that proceeding with the surgery is not advisable, so the case is canceled. This modifier is a big help to anesthesia practices, Willard says. It allows us to bill for physician time on the case.

This is done by reporting the appropriate anesthesia code for the proposed procedure, followed by the patients physical status modifier as designated by the anesthesiologist and the -53 modifier. Instead of billing for the procedures base and time units, only the related time units are billed. Many providers see this as the less desirable option because using modifier -53 reduces the base units. An example: A small bowel resection is canceled after induction. The anesthesia time involved in the procedure is 90 minutes, or six time units, with a base of three units for the discontinued procedure. The procedure would be coded as 00790-53 (anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified; discontinued procedure).

Different Needs, Different Codes

Because multiple billing options are often acceptable to carriers, an anesthesia groups billing preference may change over the years. For example, one anesthesiology group in Philadelphia used to bill for consultations if the pre-op evaluation led to a decision to cancel the planned surgery. The scope of the evaluation and time involved was consistent with a consult, so the group believed it was a good alternative. The group has found in recent years that it is impractical to bill for this type of consult because of the increased cost and level of resources needed to follow up on the claims. Instead, they seek reimbursement only for cases that are canceled after induction.

Dellinger and Willard agree that as long as you have the documentation to back up the claim, most carriers will reimburse for your involvement in canceled procedures.