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Performance Based Anesthesia coding

  1. Default Performance Based Anesthesia coding
    Medical Coding Books
    I am the sole employee of 2 Anesthesiologists. One Anesthesiologist asked me yesterday about performance based coding for Swan Ganz (donning gown and gloves) and coding for hanging Antibiotics preoperatively. He recently attended a meeting and said that he could get extra $ from insurance companies if he charts that he has provided the above service. Does anyone have any information on this. I am located in North Carolina.
    Last edited by nncymac@pinehurst; 10-07-2008 at 11:09 AM.

  2. Default Swan Ganz and PQRI
    You can bill the swan ganz as a procedure 93503 separate from the main procedure. Depending on the carrier, you may need to append a 59 modifier to indicate that this is a distinct procedure. The only caution I would give you when billing these is that if your physician also does a CVP line and the swan ganz is inserted in through the same point you can only bill one of them. The swan ganz reimburses higher so we usually go with that one.

    As for the reporting of antibiotics administered that is only for medicare, The codes are 4047F (antibiotic ordered) 4048F (antibiotic given w/in 2 hrs of incision) and 4048F-8P (antibiotic not given timely) You can report these to medicare and receive a percentage payment later. We have been directed not to report these codes to Medicare HMO's.


  3. Default
    Thanks Heather.
    Getting back to the Swan Ganz, is there a performance based code to use for Medicare for this procedure and documenting gowning and gloving?

    Also the MD has to be the one to hang the Abx preoperatively right??? I want to clarify so that the MD knows we only bill for the procedures he performs and documents.

  4. Default Swan Ganz
    I think you may be referring to the PQRI for sterile barrier technique... this is billable when a CVP line is placed and that code is 6030F. As far as I know we bill the 4047f and 4048f for both MD and CRNA if they are both on the case. If you have a CRNA only depending on the specific guidelines in your region you can bill it for the CRNA. But either the MD or CRNA needs to be the one administering the antibiotic.

    You may want to verify the criteria for both PQRI measures on the Medicare website for your region.

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