Anesthesia Coding Alert

The anesthesiologist's involvement points you in the right direction.

Coding your anesthesia provider's service is never cut and dried, especially with intricate procedures such as retrobulbar block placement. Answer these three questions regarding your anesthesiologist's involvement in the case to know how to correctly code her services every time.

Does The Anesthesiologist Handle Everything?

Because administering anesthesia for retrobulbar blocks is riskier than other ocular injections, some surgeons (or facilities) prefer to have the anesthesia team handle everything. If your anesthesiologist is involved throughout the case, she administers the initial block and then administers monitored anesthesia care (MAC) during the case.

Code it: Your anesthesiologist places the block in preparation for the procedure, not as a separate pain management service. Therefore, you only code for the eye procedure instead of the procedure and block. Choose the appropriate code from 00140-00148 (Anesthesia for procedures on eye ...). Depending on carrier requirements, append modifier QS (Monitored anesthesia care service) to indicate MAC, says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

Expect your anesthesiologist to report discontinuous time in this scenario. She will place the block, leave the room while the block takes effect, and return in time for the procedure. Because she won't be with the patient from start to finish, watch your time units. Calculate the time she spends placing the block and with the patient during the procedure for the total minutes.

Caution: Patients needing retrobulbar blocks often are scheduled back to back, which can make tracking your anesthesia provider's time tricky. Be careful to ensure that case times don't overlap when calculating the number of cases your anesthesiologist medically directs or supervises. Some practices decide to avoid potential compliance risks by not trying to capture the discontinuous time.

Does the Anesthesiologist Only Monitor?

Some facilities -- and many payers -- prefer that the surgeon place the initial block and the anesthesia professional monitor the case.

Code it: Because the anesthesiologist works in a supervisory capacity, include the appropriate medical direction modifiers for the anesthesiologist and/or CRNA as needed.

Final Tip: Check Your Guidelines

When cases involving retrobulbar blocks cross your desk, check the payer's stance before automatically coding your anesthesiologist's service -- even if she placed the initial block. Some payers bundle the retrobulbar block into the ocular surgery payment; others consider the block to be local anesthesia and bundle it with the anesthesia code. Knowing payer guidelines will help the anesthesiologist and surgeon determine the best approach to the case.

Also check the payer's diagnosis guidelines. Common diagnoses leading to eye surgery -- and possibly retrobulbar blocks -- include cataracts (366.xx), glaucoma (365.xx), strabismus (378.xx) and retinal detachment (361.xx).