Anesthesia Coding Alert

Swan-Ganz, A-lines, IVs, central venous catheter placements (CVP) these are all types of lines that anesthesia providers place for patients on a regular basis. The procedures are common, but billing and reimbursement for the services can be a gray area because some lines are bundled while others are not, and some may be bundled depending on the situation. By ensuring that adequate documentation is in place, anesthesia practices will have an easier time receiving reimbursement in the appropriate situations.


Whats Bundled, Whats Not


Some providers believe that coding for line placement is cut and dry: CVPs, Swan-Ganz catheters and arterial lines are not bundled with the procedure; IVs and related lines are. But it is not necessarily that simple for other providers because part of determining which codes to use may lie in when the line was placed and who placed it, not just which type of line was used.

If the patient is a nonsurgical patient in the ICU [intensive care unit] or is in the OR [operating room] suite or holding area when the line is placed, the placement is separate from the basic anesthesia care performed as part of the anesthesia for the patients surgery or medical care, says Jan Wirtz, owner of the anesthesia billing firm Specialty Billing Services Inc. in Waconia, Minn. Medicare determined at one point that these placements were bundled with the anesthesia service. The American Society of Anesthesiologists (ASA) fought it several years ago, and Medicare then reversed its decision so that separate billing is allowed now.

Wirtz adds that the anesthesiologist must place the line personally rather than simply be present at the placement before it can be billed. Its a flat rate fee that the anesthesiologist charges, but no anesthesia time for the service is applicable. At least thats the guideline passed down from the Minnesota Medicare carrier.

Robin Fuqua,CPIC, a certified insurance coder with the medical group Anesthesia Consultants of California in Escondido, agrees. Our rule of thumb is that we bill separately for any line that is placed by our anesthesiologists separate from the main surgical procedure, provided we do not violate any Medicare or Medicaid rules or the terms of agreement we have with various HMOs and group insururers.


Choose the Right Code


Anesthesiologists place lines for a variety of nourishment, medication or monitoring needs. Once the need is determined, the physician follows documentation guidelines, and the line placement legitimately qualifies for separate billing. There are several codes to choose from for billing purposes. Here are some examples:


36489* (placement of central venous catheter [subclavian, jugular or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis or chemotherapy]; percutaneous, over age 2) could be used for a patient having [...]