# would this be billable?



## TTcpc (Apr 7, 2010)

Patient has history of HTN on HTN meds. The patient's BP is up on date of surgery and anesthesiologist tries giving pt some Fentanyly and Versed while they are waiting for the surgeon to arrive to see if maybe it is just nerves causing BP to be more elevated than usual.  Medication does not work and patient states she feels like she may be having a panic attack (which she has a history of) and case is cancelled by anesthesiologist by the time the surgeon arrives.

Would this be billable as a discontinued case or totally non-billable?  I am still fairly new to anesthesia and most cases we have similar to this, the anesthesiologist just writes no charge on slip. 

Thank you


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## dwaldman (Apr 7, 2010)

http://www.cms.gov/NationalCorrectCodInitEd/


"3. It is standard medical practice for an anesthesia practitioner to perform a patient examination and evaluation prior to surgery. This is considered part of the anesthesia service and is included in the base unit of the anesthesia code. The evaluation and examination are not reported in the anesthesia time. If surgery is canceled, subsequent to the preoperative evaluation, payment may be allowed to the anesthesiologist for an evaluation and management service and the appropriate E&M code (usually a consultation code) may be reported. (A non-medically directed CRNA may also report an E&M code under these circumstances if permitted by state law.)"

Above excert is from the NCCI policy manual which was last revised in Oct 09 and that is probably why they refer to billing a consultation.  I also saw this other link when searching the internet where a similiar question was addressed

http://preview.aapc.com/memberarea/forums/showthread.php?t=15501


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## hgolfos (Apr 7, 2010)

Bill an appropriate E/M code if the procedure is cancelled before anesthesia is administered.  

If the procedure is cancelled after anesthesia is administered (i.e. they've noted time on the charge and have monitoring marked on the graphic record) you would bill the planned surgery code along with the V64.1 procedure not carried out for contraindication.  Be careful billing the E/M code though, because sometimes the pt's procedure is rescheduled once the problem is resolved and the anesthesia workup is still global to anesthesia services.


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