Anesthesia Coding Alert

Question: Can we bill separately for a single IV start that is separate from anesthesia delivery? One coder says some carriers accept 36410.

Michigan Subscriber

Answer: Some carriers will reimburse for IV starts, if you keep a few things in mind before coding.

First, remember that 36410 (Venipuncture, age 3 years or older, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes [not to be used for routine venipuncture]) represents service necessitating a physician's skill. You can report the code for physician services, but check with your carrier before reporting 36410 for a CRNA's service. Some carriers will accept the code for a nonsupervised or nonmedically directed CRNA who works alone to place arterial lines or provide other services an anesthesiologist would perform in the same circumstances. Designate these CRNA's services with modifier QZ (CRNA service: without medical direction by a physician).

Second, verify that your provider's documentation supports coding the IV start separately -- meaning the IV start is separate from the procedural anesthesia. Supporting documentation can include notes about unsuccessful attempts by other hospital personnel, reasons for the IV use, and specific ICD-9 codes such as 459.89 (Other specified disorders of circulatory system; other).