Anesthesia Coding Alert

Anesthesia coders don't delve into CPT's E/M codes as often as other specialties because most anesthesia codes include the pre-op exam, anesthesia during the procedure, and a follow-up visit. But there are times when you can code consultations and patient visits in addition to the procedure's anesthesia. Follow our checklists to determine whether you're losing revenue by not coding these services. Know if It's Billable in the First Place All patients go through a pre-op evaluation, which is why it is part of the anesthesia fee. That's also why coding for pre-op consults is a gray area that many anesthesia coders shy away from. Answer these questions to decide whether pre-op care qualifies as a billable consult.
 
Is the service a "starred" procedure? You can separately report "starred" procedures, those CPT codes followed by an asterisk, from other services because they  include only the surgical service (instead of being associated with pre- or postoperative services) and have zero global days. Many procedures fall into this category, such as most somatic and sympathetic nerve injections for various sites and levels (64400-64415, 64417-64445, 64450 and 64505-64530). The anesthesiologist bills the starred procedure as a single service or in conjunction with other separate procedures.
 
If you report more than one code for the visit, append modifier -59 (Distinct procedural service) to the starred code to indicate that the service was not part of another procedure. Jann Lienhard, CPC, a New Jersey anesthesia and pain management coder, also says to verify the diagnosis. "Be sure to get the correct diagnosis and reason for the anesthesiologist's visit (such as a pain management injection), not the reason the patient is in the hospital bed (such as surgery)," she says.
 
When you're dealing with starred procedures, remember that Medicare doesn't recognize this CPT designation. Instead, Medicare differentiates between "major" and "minor" procedures. Major procedures have a 90-day global period and don't include the surgeon's initial consultation or evaluation to determine the need for surgery; because of this, you report modifier -57 (Decision for surgery) with the E/M code. Minor procedures have 0- to 10-day global periods and require that a "significant, separately identifiable service" be performed in addition to the main procedure before you can report an E/M code for it. In this case, you would append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.
 
Is the service included in the global period? Anesthesia providers can also code separately for non-starred procedures that have no global period. These include injections and other pain management procedures that [...]