Anesthesia Coding Alert

Fiberoptic intubation can be used for any type of surgery when the anesthesiologist feels that it is a better option than standard intubation, such as when the patient is morbidly obese. Some coders and anesthesia providers believe billing for it is not an option because it is included in the global anesthesia fee; others feel it should qualify for separate billing.

Already Included or Separate Fee?

Medicare and Medicaid in some states will not pay for fiberoptic intubation. Their policies state that it is included with the global anesthesia fee, therefore providers are not allowed to bill for it. But some HMOs, private insurers or other carriers will pay for it as a separate service. If this is the case in your area, some coders recommend filing the claim with modifier -22 (unusual procedural services), which applies to services that go beyond what is normally required for the listed procedure, as in treating the patient who is morbidly obese. It is not one of the most common modifiers used for anesthesia services but applies to this situation.

Part of the problem in billing fiberoptic intubation separately is that it is not a stand-alone procedure, which means there are no base units associated with it. Some carriers that allow separate billing may accept it filed with modifier -22 and three additional units, such as some California carriers do.

Procedure or Anesthesia Administration

If fiberoptic intubation is performed for diagnostic purposes rather than the administration of anesthesia, it can be billed using the surgical code CPT 31575 (laryngoscopy, flexible fiberoptic; diagnostic). An emergency intubation would be coded with CPT 31500 (intubation, endotracheal, emergency procedure). Coders agree these are appropriate times to bill for fiberoptic service and do not have problems receiving reimbursement when the case is adequately documented. Billing for fiberoptic intubation is difficult, according to Karen Maloney, billing manager with Physicians Billing Network in Newark, Del., which does billing primarily for anesthesia practices. Intubation is included in the global anesthesia fee, so you may not be able to bill for fiberoptic intubation if it precedes surgery, she says.

Scott Groudine, MD, associate professor of anesthesiology at Albany Medical Center in New York, agrees. Securing an airway for anesthesia is part of the global anesthesia, he explains. How you do that is up to you, and the method of intubation is irrelevant when the procedure is coded. There is no difference in coding whether the patient is intubated retrograde with a Wu scope, a fiberoptic scope, a lighted stylet or using standard technique.

There are easy ways to intubate patients and more difficult ways, he adds. Obviously, if you do a fiberoptic intubation and it takes more time, that increased difficulty will be reflected in the increased time units associated with the procedure.

Before attempting to seek additional reimbursement for fiberoptic intubation as the method of anesthesia administration, check with your local carrier for any criteria that must be met and documented.