Anesthesia Coding Alert

Follow this guide to help assign the correct code The surgeon's global fee for procedures includes routine pain management, but surgeons often ask for help with more difficult cases. If your pain management specialist evaluates patients for postoperative pain management, verify that you can code for the service -- and be sure you assign the correct-level code. Meet the Requirements   Before you can code a visit as a consult, your physician must meet certain criteria. In the past, physicians had to meet guidelines known as "the three R's" of consult coding, but now the guidelines have expanded to include four R's instead: request, reason, render (an opinion) and report.

"Reason" is the newest addition to the requirements and can be difficult to substantiate.
 
"The main problem with the fourth R is getting the physician to dictate the reason for the consult," says Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif.

"Simply indicating 'pain consult' will not justify a consult code," Johnson says. "Now the documentation must indicate specifics such as 'patient with low back pain, referred by Dr. A for consult' to show the reason for the request." Check Out the Options CPT 2006 made some changes to consult codes, including deleting the follow-up inpatient consultation codes. Now you should report subsequent care codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...) for these situations, according to CPT notes.
 
Selecting the correct code depends on the level of care provided: the amount of medical history taken, the extent of physical examination given, and the complexity of medical decision-making.

The global anesthesia fee includes routine postoperative management, and the global surgical fee includes routine postoperative surgical care (including pain management).

"If an anesthesiologist has seen the patient, and the patient is referred by another physician (with a written request outlining the necessary information and why this patient is more complicated than the typical post-op patient), you can consider billing the service as a consultation," says Scott Groudine, MD, an anesthesiologist in Albany, N.Y.

That's when documentation can help justify coding a consult for the patient.
 
Watch Times for Coding Clues In most cases of inpatient consults, you'll report 99251 for consultative post-op care, Groudine says, "because the history and physical is problem-focused (limited to pain), and the medical decision-making is straightforward with an average time of 20 minutes spent with the patient."

Time it: Encouraging your physicians to keep timed notes will lead to more accurate coding. The length of the visit can give you insight into the visit's complexity, Groudine says. 

CPT tip: Notes following each of the consult codes in CPT include an explanation of how complex the [...]