# E/M visit for an Anesthesiologist



## NESmith (May 30, 2012)

Our anesthesiologist has been told by other providers that he can bill either a consult or an E/M services if the specialist request the anesthesiologist talk with the patient before the specialist decides to perform a procedure. Is this true and where can I find this in writing?

Thanks for your help.


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## dwaldman (May 30, 2012)

Per the NCCI edits----majority of  E/M codes are bundled (no modifier allowed) into anesthesia codes other than critical care codes.

Below is from the NCCI policy manual which describes the preoperative evaluation be included in the anesthesia care package. As seen below, if the provider is asking the anesthesiologist to meet with the patient because they need to double check surgical clearance -----this type of activity on the day the anesthesia services are provided still are described as be inclusive.


Anesthesia care is provided by an anesthesia practitioner who may be a physician, a certified registered nurse anesthetist (CRNA) with or without medical direction, or an anesthesia assistant (AA) with medical direction. The anesthesia care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and post-anesthesia recovery care.
Preoperative evaluation includes a sufficient history and physical examination so that the risk of adverse reactions can be minimized, alternative approaches to anesthesia planned, and all questions regarding the anesthesia procedure by the patient or family answered. Types of anesthesia include local, regional, epidural, general, moderate conscious sedation, or monitored anesthesia care (MAC). The anesthesia practitioner assumes responsibility for anesthesia and related care rendered in the post-anesthesia recovery period until the patient is released to the surgeon or another physician.

Similarly, routine postoperative evaluation is included in the base unit for the anesthesia service. If this evaluation occurs after the anesthesia practitioner has safely placed the patient under postoperative care, neither additional anesthesia time units nor evaluation and management codes should be reported for this evaluation. Postoperative evaluation and management services related to the surgery are not separately reportable by the anesthesia practitioner except when an anesthesiologist provides significant, separately identifiable ongoing critical care services.


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## NESmith (May 31, 2012)

Thank You as always for your quick response, but I have another question. Can an E/M be billed if the anesthesiologist sees the patient weeks before any procedure is ever scheduled? Other providers are telling our anesthesiologist that he can but once again I am not so sure.


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## dwaldman (Jun 1, 2012)

Q16. Can we bill for a pre-operative exam on a 90-day global surgery procedure if the service is performed more than 1 day prior to the surgery?

A16. You can bill the medically necessary service to Medicare without any modifiers. The global surgery period for a major surgery includes the day before, the day of and 90 days after the major (090 global days) surgery.

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Although this is not directly related to your scenario.  You would be able to bill visit if is medical necessary for the anesthesiologist to see the patient prior to the day of the surgery would be my intrepretation in place of having a direct published source to your specific question.

http://www.wpsmedicare.com/j5macpartb/resources/provider_types/2009_0810_emglobpkg.shtml


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## hgolfos (Jun 4, 2012)

I agree and would add that this is because anesthesia personnel are required to eval the patient no more than one day prior to surgery, so they are in actuality providing the service twice.  I've had a similar situation come up. Occasionally one of our providers is asked to evaluate morbidlly obese pregnant mothers for C-section clearance weeks ahead of time, because the facility is somewhat limited in what they are able to handle.  Sometimes, based on the provider's assessment, the patient is referred to a larger facitlity.  Sometimes not.  In either case the service provided is outside the one day time limit and when the patient actually has the procedure the pre-anesthesia eval is re-done.


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