Anesthesia Coding Alert

Fifteen to 20 percent of our physicians time is spent inserting catheters, says Mary Ann Trumpower, coder for Eastern Panhandle anesthesia in Martinsburg, W.Va. Thats why its so important to know whether the procedure is bundled with other services. Fortunately, catheter insertion codes are no longer bundled with other procedure codes, says Scott Groudine, MD, chairman of the government, legal and economic affairs committee of the New York Anesthesia Society.

Three of the most commonly used catheter insertion codes had been bundled with primary procedure codes and, therefore, were not billable separate fees. They are:

1. CPT 36620 (arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous);

2. CPT 36489 (placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous; over age 2); and

3. CPT 93503 (insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes).

Medicare clearly understands that the three codes for A-lines, CVPs and Swan-Ganz catheters are not bundled into anesthesia code and should get paid separately, Groudine says. This is a national policy, and all Medicare carriers must pay for these procedures if theyre medically necessary. Local carriers occasionally might deny separately billed procedures, but anyone who can prove medical necessity should fight the denial and be able to win.

Seeking reimbursement from other payers is a bit more complicated because their catheter-insertion policies vary regionally. For example, Blue Cross of Wisconsin, Maryland and Alabama recently considered bundling these procedures to some anesthesia codes. Blue Cross of Wisconsin claimed that central lines and A-lines are standard care for some surgeries, such as coronary artery bypass grafts, and therefore are not unusual monitors of care. Groudine says this view contradicts anesthesia guidelines, which state that unusual forms of monitoring (e.g., intra-arterial, central venous and Swan-Ganz) are not included as part of the usual pre- and postoperative visits, anesthesia care during the procedure, the administration of fluids and/or blood and the usual monitoring services (such as ECG, temperature and blood pressure).

Despite this conflict with CPT guidelines, coders say some large carriers, such as Blue Shield of California, still consider line placements bundled with anesthesia codes and, consequently, part of anesthesia delivery. This happens most frequently with claims for major procedures such as heart surgery. In this case, some anesthesiologists might write off the charges if the catheter was placed during his or her time in surgery, but will press for payment if the catheter was placed later because the service was performed separately from the main procedure.

Document Medical Necessity to Avoid Rejection

Documentation of heart problems, malignancies or organ failures satisfies medical necessity requirements for catheter [...]