Learn Billing and Coding for ICU Care
Published on Wed Nov 01, 2000
Anesthesia care is often finished once the patient officially transfers from the care of operating room staff to the postanesthesia care unit (PACU) staff. But sometimes anesthesia care is still needed in special situations. A patient may be moved from PACU to the intensive care unit (ICU) because of an irregular heartbeat, respiratory failure, drug-induced coma, other complications of surgery or other unusual circumstances. Since billing for anesthesia is not normally needed in these circumstances, getting reimbursed can be frustrating and tricky. But coding professionals and care providers can obtain appropriate reimbursement with good documentation, patience and a good working relationship with the carrier.
Why Is Anesthesia Coding Difficult?
Many people in the field believe that anesthesia coding is more difficult than for other specialties because of the way the system is structured. Does the carrier want surgical codes or anesthesia codes? Do you use codes from the ASA Crosswalk even if they are not included in CPT Codes, or stick with CPT-sanctioned codes? Which code do you use to figure base units when several different procedures are performed under the same anesthesia administration? The questions go on and on, and the answers which can be tricky in any situation get even trickier when the patient being treated is in ICU.
Coding for anesthesia in ICU is very difficult, says Cindy Lane, a coder in the anesthesia department of Vanderbilt University in Nashville, Tenn. Information about it is very hard to find. I spend a lot of time consulting with other people trying to find out what others do and how well it works.
When May ICU Care Be Necessary?
Separate anesthesia billing should be the exception, rather than the rule, for ICU patients, says Leisa Gonnella, anesthesia administrator at the University of Virginia in Charlottesville, Va. The surgeon is paid to do routine post-operative care, she explains, and we have been told that routine can include care in the ICU. But there are certain situations when anesthesia care is merited for ICU patients.
Anesthesia providers may assist in transferring patients who are on ventilators and need vasoactive drips from PACU to ICU. Billing for this service can be awkward because patients are often taken for x-rays and other studies by nursing staff and respiratory therapists instead of by anesthesia staff. If the patient is monitored and vital signs are recorded on the anesthesia record during transportation, this time could be billed as discontinuous anesthesia time.
Many anesthesia providers usually work with ICU patients when they are on a ventilator or need arterial lines or central venous catheters placed. [...]
