Anesthesia Coding Alert

Question: Our anesthesiologist placed a central line, arterial line and a double-lumen catheter and provided anesthesia. His notes indicate that he used a bronchoscopy for tube placement and would like to bill for this plus everything else. Is this acceptable or is everything bundled?

California Subscriber
 
Answer: All intubations are bundled, regardless of the method or type of tube used. The reason that base units for thoracic procedures are higher than units for many other procedures is because these additional efforts, such as placing double lumen tubes, are already factored in. However, some carriers will pay for additional lines with appropriate documentation. If this is the case, append modifier -59 (distinct procedural service) to the procedure code (36533, insertion of implantable venous access device, with or without subcutaneous reservoir, or 36620, arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure], percutaneous, or 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) to show that additional services were performed. Clearly document that the anesthesiologist placed the line, rather than monitored it. Since policies can vary, check with the carrier in question before attempting to bill the lines separately.