E/M question for anesthesia

Anna Weaver

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I am new to anesthesia coding and have a question concerning E/M coding with anesthesia. Is it something that is done regularly? My understanding of what I have read is that they can do an E/M if it's over and above the usual problem focused pre and post surgery. This anesthesiologist will be doing Intrathoracic surgeries (CABG and pulmonary). Most of these patients will be in bad health originally, so would that be common to have a separate visit? Or would even these patients be included in the usual pre and post visits? Thanks!
 

myeo

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The uniqueness in anesthesia coding is that anesthesiologist code by the start and stop times that they are with the patient. So, if your doctor remains with the in patient in the PACU after surgery, then the time he/she spends with the patient is still considered part of the anesthesia time. Now , if there is a break in time, that is different.
 

comunale

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pre-op E/M

I believe you can bill for a new or established patient visit to cover the pre-op exam if done by the anesthesiologist and then the case is cancelled because there will be no global rules as the surgery was not started.
CodinginCA
 

jdrueppel

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http://www.cms.hhs.gov/center/anesth.asp

On the right had side of this attachment is "Chapter 2 - Anesthesia Services" from CMS. It's a great learning and reference tool that I give to my coders. The ASA (American Society of Anesthesiologists) Relative Values Guide is another excellent reference.

In regards to your question of billing an E&M in addition to anesthesia. In general, it is not appropriate to bill an E&M with your pre-anesthesia service UNLESS, as stated by another responder, the case is cancelled before induction and you are capturing the time (but not reporting time units) and work of the pre-anesthesia for your provider. The pre-anesthesia evaluation is part of the base unit value for the anesthesia service. The physical status modifiers and ASA base unit values take into account that you may have a more unstable patient for cardio or pulmonary services with base units of 12 to 25 units.

Julie
 
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sandyy2510

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?

Julie,

How about when:

When the anesthesia billed for procedures (for gastric bypass) and
(unknown) in which the procedure was canceled before induction of anesthesia. Can they bill 01999?? Only IV fluids and some non-anesthesia Meds were given. I think that 01999 may be appropriate (vs mod 53) but don't know at what level do we say that they actually did this? And should be reimburse for being in the OR room?????
 

jdrueppel

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Sandy,
Per CMS guidelines (Back to the Chapter 2 attachment noted on my previous response) - when procedure is cancelled before induction it is appropriate to bill an E&M. This could even be a consultation if your documentation supports it. We typically bill an inpatient or outpatient E&M as documentation doesn't meet the "request" for consult guidelines because the surgeon's order for anesthesia (or be seen by anesthesia) is a standing order versus a true request for consultation.

Interestingly, we have just recently started experiencing payment problems from ONLY Medicare and Medicaid, and only for our CRNA E&Ms for cancelled cases. In the state of Nebraska our CRNAs can personally perform services. We changed Medicare carriers to WPS in March an are still in the process of educating them :) I'm confident that eventually Medicare and Medicaid will pay. All other carriers pay our E&M charges for cancelled cases.

In regards to the -53 modifier - I have been told and this information was re-interated during an audit (we hire a company to audit us every year for compliance) that this modifier is not appropriate on a multiple unit based fee so we don't use it on any of our anesthesia services. That's not to say it's never appropriate as we all know, many payers make up their own rules. I do, however, use if on our surgical fees (for example - a discontinued central line placement).

Regarding getting reimbursed for OR Room - I'm assuming you're talking about the "time" your provider spent in the OR before case was cancelled. If there is significant time and you meet the guidelines you could bill prolonged attendance in addition the the core E&M code. I don't have my CPT book with me so I can't quote the exact codes for prolonged attendance.

When I get to talking about coding and anesthesia I get a little exited and alot windy - so I'm sorry if this is too much info.

Julie
 
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