Anesthesia Coding Alert

Documentation helps direct whether you bill separately You can usually code invasive line placement and monitoring separately from the procedure's anesthesia, but all lines aren't created equal. Get up to speed on when -- and how -- to correctly report arterial lines and boost your accuracy before coding your next multi-line case.
Watch for A-Lines With Trauma Patients Physicians use arterial lines (commonly called A-lines) to measure the patient's blood pressure and to provide easier access for drawing blood to study bloodstream gases. This helps the anesthesiologist evaluate how well the patient's lungs are working by how well they move oxygen into the bloodstream and remove carbon dioxide. The line also provides a reliable method to frequently check arterial blood samples so the anesthesiologist can respond appropriately. Who needs them: Unstable patients who are having surgery because of trauma often need A-lines. So do patients undergoing cardiac, vascular, chest, spine or brain surgery because these patients are subject to rapid blood pressure changes, according to the American Society of Anesthesiologists' (ASA) statement on invasive monitoring procedures.
Opt for 36620 More Often Than 36625 The primary code for A-line placement is 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous). Code 36625 (... cutdown) also applies to A-line placement, but you'll rarely report it because anesthesiologists normally use the percutaneous approach instead of cutdown, says Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif. On the rare occasions that require cutdown placement because the anesthesiologist is unable to locate the patient's artery through the skin, the physician creates an incision and inserts the catheter under direct vision. The anesthesiologist might not have credentials to perform this open procedure, so the surgeon performs and codes for it instead. In this case, you won't report the procedure because your physician is only monitoring the line rather than placing it, and monitoring is part of the global anesthesia fee. To bill or not: The biggest question many coders have regarding A-line insertion is whether to report the service separately or include it with the global anesthesia fee. The answer, experts say, depends on when your physician places the line. "We follow the line of thinking that we charge for placement if the patient has been induced," Johnson says. "This requires monitoring of the patient while the anesthesiologist is placing the line."
Verify That Documentation Meets Guidelines Coders rarely have problems gaining separate reimbursement for any arterial lines they do report, if the physician clearly documents their placement. Expect to receive payment for three base units for 36620 or five base units in the rare instance you report 36625. Note: Some carriers pay a flat fee [...]