Anesthesia Coding Alert

How well do you know the ins and outs of billing E/M services separately from services included in the global anesthesia fee? Test your knowledge with four cases: The anesthesia provider is routinely asked to see inpatients the night prior to surgery to evaluate the patient and order any required labs. This visit may be completed by the anesthesiologist or the CRNA. It is not billable, because it is included in the anesthesia preoperative evaluation. A mom-to-be is in early labor and has not been administered an epidural for pain management. The baby is noted as having fetal heart decelerations. Mom is taken to the OR for a cesarean section. The anesthesia provider examines her, gains her consent and does other preliminary work before she is medicated and induced. The baby's heart rate settles down, everything looks normal, and the c-section is canceled. E/M can be billed for the care that has taken place so far. When the baby is delivered later, any anesthesia associated with the delivery (whether an epidural or anesthesia for a c-section) can also be billed. A patient's pre-op work is completed on Monday for a case that is scheduled for Wednesday. The case is cancelled on Wednesday morning when the patient arrives for the procedure and has a cold. The case is rescheduled for two weeks later to ensure that the patient will be well. Most anesthesiologists will bill an E/M code for the preoperative work since it will need to be repeated closer to the time of the actual procedure. A patient is in the pre-op holding area and is ready for surgery. His case is canceled because a trauma patient must be treated first. The first patient's case is rescheduled for the next morning. Most coders will not bill separately for the patient's pre-op work because the surgery will be performed in such a short time and most pre-op work should not need repeating.