Page 1 of 2 12 LastLast
Results 1 to 10 of 11

E/M question for anesthesia

  1. #1
    Default E/M question for anesthesia
    Medical Coding Books
    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!

  2. #2
    Orange County
    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.

  3. #3
    Default 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.

  4. #4

    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.

    Last edited by jdrueppel; 09-26-2008 at 07:00 PM.

  5. #5
    Default E/m question
    Thanks for the responses. It helps tremendously.

  6. #6
    Jamaica/ Manhattan
    Exclamation ?

    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?????

  7. #7
    Jamaica/ Manhattan
    also how about 99252-57? just to pay for their time

  8. #8
    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.

    Last edited by jdrueppel; 10-02-2008 at 07:27 AM.

  9. #9
    Jamaica/ Manhattan

  10. #10

    You're welcome.


Page 1 of 2 12 LastLast

Similar Threads

  1. Anesthesia question
    By in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 06-06-2011, 09:17 AM
  2. anesthesia question
    By dgoya in forum Employment General Discussion
    Replies: 0
    Last Post: 07-14-2010, 03:47 PM
  3. Anesthesia question
    By sriggle in forum Anesthesia
    Replies: 2
    Last Post: 11-19-2009, 09:33 AM
  4. Anesthesia question!
    By Amanda_Kentch in forum Anesthesia
    Replies: 3
    Last Post: 03-28-2008, 10:33 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.