Wiki Anesthesia Billing

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mandrews582000@yahoo.com

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Team,
My company is tasked with billing anesthesia charges for a multi-specialty practice to a wide range of payers. We are out of network by choice. When billing the charges, we use modifier 51 for all J codes as well as the drug administration charge. All codes excluding the anesthesia service are being globalized into the 01??? anesthesia code. Is there a more appropriate way of billing these charges.

Please advise
 
Not sure why you're using modifier 51 for J codes - that modifier is for surgical procedures and isn't appropriate for a drug HCPCS code. If these services are being provided in a facility, you wouldn't bill for the drug charges as these would be provided and billed by the facility. If the service is done in your provider's office, you can bill the drug charge and no modifier should be necessary. Depend on the drug and payer policy, however, it may be considered inclusive to the professional surgical or anesthesia payment.

As for the drug administration charge - administration of the anesthesia drugs and fluids is a component of all anesthesia services - you should not bill an administration code for this as that would be unbundling. If the anesthesiologist performs a drug charge that is separate and unrelated to the anesthesia service, you may be able to bill this as a separate procedure with modifier 59, but it would need to be supported as such in documentation. I'd recommend reviewing chapter 2 of the CMS NCCI manual which provides a lot more detail as to which anesthesia services are inclusive and which may be billed separately.
 
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Thomas,
Thank you so much. The J codes are drug codes like J3010, J2704, etc. These drugs are purchased by the ASC and I am billing the 96372/1 unit. Not charging anything for the IV fluids, Lido,etc. Only those major drugs delivered IV push. Do you still think this is unbundling? I will use 59 going forward! I just read all 18 pages of CMS NCCI Chapter2 and it cleared things up significantly.

Once again Thomas, I thank you so very kindly for your insightful response.
 
I'm not an anesthesia coder but I'm pretty sure that billing 96372 for administration of drugs such as the fentanyl or propofol during surgery would be unbundling. As the manual states, "Anesthesia services include, but are not limited to, preoperative evaluation of the patient, administration of anesthetic, other medications, blood, and fluids, monitoring of physiological parameters, and other supportive services." Documentation would need to support that an administration was unrelated to the anesthesia care package in order to bill that code with a modifier to unbundle it.

If the drugs are purchased by and administered in the ASC, then they should not be billed on the professional claim for the anesthesiologist. ASC facility billing has specific rules as to what items can be billed as separate line items and which should be rolled up into the charge for the surgical procedure so those charge should be left to the facility coders and billers.

Hope this helps some more.
 
Thomas...I appreciate your insightful input. Thanks so much. My career has lead me to an executive role but I am finding myself re-learning the "Nitty Gritty"!
 
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