Anesthesia Coding Alert

Nugget: Before performing office-based anesthesia procedures, anesthesiologists should verify coverage for equipment costs, which are not usually reimbursed adequately.

Anesthesiologists can be reimbursed for office-based anesthesia (OBA) by including the place-of-service code. As more medical procedures are being performed on an outpatient basis and as more anesthesia professionals are offering pain management services, OBA is becoming more common.

Surgeons are performing procedures in their offices ranging from tonsillectomies and implanting tubes in ears to arthroscopic surgery on knees and shoulders. This growing practice leads to increased requests for anesthesiologists to provide OBA for other healthcare providers outside the hospital setting.

Coding for OBA is not very different from coding for hospital-based procedures.

Coding for OBA Procedures

Ricki Kudowitz, a coding professional for the nine-physician group Anesthesia and Pain Management of Western Queens in Englewood, N.J., says that the only code variations are associated with the place of service.

Each state has a list of two-digit codes from Medicare that indicate the place of service; for example, Mary Phillips, owner of Northwest Codify Medical Billing and Accounting Services Inc. in Tacoma, Wa., says the code in Washington for ambulatory service centers is 24. This code goes on line 24 of the HCFA 1500 form along with the address for the place of service. Otherwise, documentation of the case and the procedure codes remain the same as in any other facility.

Office-based anesthesia is being used more frequently for procedures offered by specialists such as plastic surgeons, pediatric dentists, and ear, nose and throat physicians. Phillips says that eye surgery centers are another common OBA site. She offers the following examples of how to code for OBA procedures:

A child is treated for large amounts of dental cavities by a pediatric dentist: use the appropriate two-digit code to indicate the place of service, and 41899 (unlisted procedure, dentoalveolar structures) for the procedure itself.

An adult has a cataract removed at a freestanding eye surgery center: Code for the place of service, and code 66984 (extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]) for the procedure.

An ear, nose and throat specialist performs a tonsillectomy and adenoidectomy in his office on a 9-year-old child: Code for the place of service, and code 42820 (tonsillectomy and adenoidectomy; under age 12) for the procedure.

Be Wary of Equipment Costs

Kudowitz and Phillips agree that getting reimbursed for the actual OBA procedure [...]