Anesthesia Coding Alert

Sometimes bill for both services, sometimes only one When a surgeon calls in your anesthesiologist to perform an epidural blood patch, you might be on the fence as to what services you can report. Can you bill a consult in addition to the blood patch? A subscriber posted this question on the Anesthesia & Pain Management Coding Alert listserv and received some interesting responses. Decide how you would handle it, then see how your solution measures up to four factors our experts recommend you consider before automatically reporting the consult. Factor 1: Verify That It's Consult-Worthy Needing an epidural blood patch is a known anesthesia complication, but that doesn't mean you automatically code for the consult. Reporting the consult depends on your group's policies and whether your anesthesiologist was involved in the original procedure.

With those factors in mind, start by verifying that the case meets the four criteria (known as the Four R's) for a consult:
  You have a formal request - in writing - from the surgeon asking your physician to perform a consult
  You have documentation in the patient's chart of the reason for the consult and the opinion being sought
  Your anesthesiologist conducts a review of the patient and the circumstances
  Your anesthesiologist renders an opinion about the patient's situation - and shares that opinion in writing with the requesting physician. "Be sure the consultation has the proper documentation to support it," says Jann Lienhard, CPC, a New Jersey coding consultant. "Also be sure the physician's chart notes are up to speed for the level of consultation being performed."

Code it: If documentation supports a consult - and if billing a consult is appropriate according to your group's guidelines - you'll probably report 99251 (Initial inpatient consultation for a new or established patient, which requires these three key components: a problem-focused history; a problem-focused examination; and straightforward medical decision making ... Usually, the presenting problem[s] are self-limited or minor. Physicians typically spend 20 minutes at the bedside and on the patient's hospital floor or unit). 

Codes CPT 99252-CPT 99255 are other options in this series, so report whichever service the documentation supports, says Julee Shiley, CPC, a South Carolina coding consultant.

Diagnosis: Also check that the patient's diagnosis meets medical-necessity criteria for a consult. The most common diagnosis supporting an epi blood patch is post dural puncture headache (or PDPH) (349.0, Reaction to spinal or lumbar puncture).
 
PDPH is a well-recognized complication of dural puncture, whether the puncture is accidental or intentional (medical journals report 80 percent of patients complain of headache following dural puncture). Most headaches occur on the first day following dural puncture. Shiley says that headache (784.0) is another frequent diagnosis for the consultation if [...]