Anesthesia Coding Alert

Question: I-m doing some fill-in coding for an anesthesiologist who writes an -E- beside each of his cases. What does this mean?


South Carolina Subscriber
 

Answer: According to the American Society of Anesthesiologist's Relative Value Guide (RVG), services with an -E- noted by the patient's physical status indicate anesthesia complicated by emergency conditions. Some carriers will pay two or more additional units when the service meets the definition of an emergency.

Consider several factors before submitting every claim with an -E.- First, every case is not an emergency. According to the RVG, an -emergency- is -defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part.- Just because the case is done at after hours does not justify an emergency charge. Some physicians still argue that because the case is -unexpected- it is an emergency, and you should discuss this with the anesthesiologist.

Caution: Also remember that constantly billing qualifiers such as emergency conditions may increase your chances of an audit.

If you do find that the cases are emergencies, report +99140 (Anesthesia complicated by emergency conditions [specify] [list separately in addition to code for primary anesthesia procedure]) on the same day as the primary procedure; list the code on the second line with 1 unit in Box 24G of the CMS-1500 form; and report type of service 1 or 2, whichever applies.