Anesthesia Coding Alert

Know whether extra services help or hurt your claim

Your anesthesiologist is medically directing three cases when he's asked to step out and assist with a service for another patient. Is he still able to report the initial cases as medically directed? Here's how to decide. Count These 'Extra Services' Toward Medical Direction - if They're Quick Determining whether cases can be coded as medically directed is challenging for almost every coder. Some coders blame the vague terms CMS chose for its seven rules for reporting medical direction (see "Coding Supervision Changes Your Fee" in a later section of this article for a list of these criteria).

HCFA muddied the waters even more by stating that the medically directing anesthesiologist may perform other duties concurrently (sometimes known as the "Six permissible sins" of medical direction). These duties include:
  Addressing an emergency of short duration in the immediate area
  Administering an epidural or caudal anesthetic to a patient in labor
  Performing periodic, rather than continuous, monitoring of an obstetrical patient
  Receiving patients entering the operating suite for the next surgery
  Checking or discharging patients in the PACU
  Coordinating scheduling matters. One of the most common questions regarding these "exceptions" is: What constitutes an emergency of short duration? Specific answers might vary from one coder to the next, but the consensus is usually the same: It's a judgment call.

"Each practice must decide on its own how to interpret 'short duration,' " says Denise Giliberti, CPC, practice manager for NM Anesthesia Associates PC in New Milford, Conn. "It depends on the size of the facility in which you work. Can a physician who is helping in the ED or ICU of a large hospital really get back to the OR quickly enough? In our hospital, the ICU is across the hall. In some larger hospitals, it is in another wing. It really comes down to a decision the group must make." Documentation Can Help Support 'Short Duration' Some services are fairly easy to justify as emergencies of short duration, which means you shouldn't have trouble with reimbursement. Donna Howe, CPC, of Anesthesiology Associates of Eastern Connecticut in Manchester says the most common examples in her group are intubation for adults in respiratory arrest and for infants with meconium (31500, Intubation, endotracheal, emergency procedure).

Other examples include treating nearby PACU patients with problems such as hypotension (458.x, Hypotension), respiratory distress (786.09, Dyspnea and respiratory abnormalities, other; 518.82, Other pulmonary insufficiency, not elsewhere classified; or 518.5, Pulmonary insufficiency following trauma and surgery) or inadequate [...]