Anesthesia Coding Alert

When billing for services outside the global anesthesia fee, some coders might shy away from separate E/M codes for fear that they bring extra scrutiny. But there are times when circumstances merit billing for additional services, and not using E/M codes when appropriate can cost an organization its fair share of reimbursement. By familiarizing yourself with situations that qualify for separate E/M billing and knowing how to select the most appropriate code for services, you can help capture some charges that might otherwise be overlooked. Keep the following questions in mind when you're faced with E/M coding. Are You Meeting the Requirements? The first step in knowing whether E/M codes can be used is to learn the requirements for consults. One way some coders remember E/M criteria is by noting the three R's request, render and respond. All of these criteria must be met before time spent with a patient can be coded as an E/M service:
  The request for the anesthesiologist's consult must be in writing in the patient's chart. The anesthesiologist renders service to the patient. The anesthesiologist responds to the requesting physician in writing with the exam results, recommendations for further treatment, and other pertinent information. Documentation clarifying why a consult was performed instead of a routine pre-op exam must be included in the anesthesiologist's notes. Such documentation should include the length of time before surgery and why the request was made.

For instance, a patient over age 70 with multiple medical problems (cardiac, hypertension, history of bad response to anesthesia, hypothyroid, etc.) is scheduled for surgery. The surgeon requests an anesthesia consult to determine whether the procedure can be performed under MAC (monitored anesthesia care) or regional anesthesia. Billing the anesthesiologist's time with the patient as a separate consult rather than including it as part of the routine preoperative exam is appropriate because he is making a higher-level decision than in a normal preoperative situation. Documentation of the E/M visit must also include information regarding the patient's medical history and physical examination as well as the anesthesiologist's medical decision-making. The consultation's level of service depends on whether the physician meets or exceeds CPT guidelines for each of these components (history, exam and medical decision-making). Is the Preoperative Consult Billable? "Typical preoperative evaluations for the purposes of undergoing an anesthetic cannot be billed as consults," says Lewis Woodell, director of reimbursement and compliance in the anesthesia billing office of Summit Healthcare in Fort Worth, Texas. "However, consults on potential surgical candidates that are done more than 72 hours prior to surgery might be billable."

Consults for certain services are billable regardless of the time frame. For [...]