Anesthesia Coding Alert

Eye surgeries are some of the most commonly performed outpatient procedures that anesthesiologists assist with. But although some of the procedures can be quick and easy (comparatively speaking) for the surgeon, coding for the anesthesia portion can change from case to case. A physician administers a pain block before the procedure begins, and a physician or other qualified anesthesia professional monitors the patient during the procedure. The coding challenge lies in knowing who is involved from an anesthesia standpoint during each portion of the procedure so you can report the services appropriately. Case 1: Anesthesiologist Places Block, Nurse Observes "If the anesthesiologist administers the presurgical retrobulbar block (the type of block most common for eye procedures), it can technically be coded as a stand-alone procedure instead of anesthesia services, according to CPT Codes and ASA guidelines," says Teresa Law, an independent anesthesia coding consultant with Physician Groups Ltd. in Winnepka, Ill. "But coding gets complicated if the anesthesia provider leaves once the block is in place and a nurse monitors the patient instead." As long as the anesthesia provider is still present, the case is considered monitored anesthesia care (MAC). But once the anesthesiologist transfers the case to a nurse, Medicare guidelines maintain that it becomes a conscious sedation case. (That's because only anesthesia assistants [AA], certified registered nurse anesthetists [CRNA], and physicians trained in anesthesia can bill MAC services. By definition, MAC is excluded if a registered nurse monitors the patient.)

In this scenario, the anesthesiologist codes the initial block as a stand-alone procedure with CPT 67500 * (Retrobulbar injection; medication [separate procedure, does not include supply of medication]) but doesn't bill for the conscious sedation provided by the nurse (99141, Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation). If this is how the physicians at your facility handle these cases, be sure you know each carrier's reimbursement guidelines. Some carriers include retrobulbar blocks in the ocular surgery payment, while others consider the block to be local anesthesia and bundle it with the anesthesia codes. If the carrier you're dealing with bundles the block payment with the surgical code, the surgeon and anesthesiologist should negotiate a fee arrangement. Case 2: Surgeon Places the Block,
Anesthesiologist Monitors  A more common approach to eye procedures involves the surgeon administering the initial block, and the anesthesia professional monitoring the case.

 "At our facility, the surgeon administers the blocks for eye cases, and we only administer MAC (unless the patient is a baby or if other special circumstances apply)," says Vicki Embich, a coder in the anesthesia department of West Florida Medical Center Clinic in Pensacola. "We only bill for the total sedation time, which in these cases can be [...]