Anesthesia Coding Alert

Nugget: Before performing office-based anesthesia procedures, anesthesiologists should verify coverage for equipment costs, which are not usually reimbursed adequately.

Anesthesiologists can be reimbursed for office-based anesthesia (OBA) by including the place-of-service code. As more medical procedures are being performed on an outpatient basis and as more anesthesia professionals are offering pain management services, OBA is becoming more common.

Surgeons are performing procedures in their offices ranging from tonsillectomies and implanting tubes in ears to arthroscopic surgery on knees and shoulders. This growing practice leads to increased requests for anesthesiologists to provide OBA for other healthcare providers outside the hospital setting.

Coding for OBA is not very different from coding for hospital-based procedures.

Coding for OBA Procedures

Ricki Kudowitz, a coding professional for the nine-physician group Anesthesia and Pain Management of Western Queens in Englewood, N.J., says that the only code variations are associated with the place of service.

Each state has a list of two-digit codes from Medicare that indicate the place of service; for example, Mary Phillips, owner of Northwest Codify Medical Billing and Accounting Services Inc. in Tacoma, Wa., says the code in Washington for ambulatory service centers is 24. This code goes on line 24 of the HCFA 1500 form along with the address for the place of service. Otherwise, documentation of the case and the procedure codes remain the same as in any other facility.

Office-based anesthesia is being used more frequently for procedures offered by specialists such as plastic surgeons, pediatric dentists, and ear, nose and throat physicians. Phillips says that eye surgery centers are another common OBA site. She offers the following examples of how to code for OBA procedures:

A child is treated for large amounts of dental cavities by a pediatric dentist: use the appropriate two-digit code to indicate the place of service, and 41899 (unlisted procedure, dentoalveolar structures) for the procedure itself.

An adult has a cataract removed at a freestanding eye surgery center: Code for the place of service, and code 66984 (extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]) for the procedure.

An ear, nose and throat specialist performs a tonsillectomy and adenoidectomy in his office on a 9-year-old child: Code for the place of service, and code 42820 (tonsillectomy and adenoidectomy; under age 12) for the procedure.

Be Wary of Equipment Costs

Kudowitz and Phillips agree that getting reimbursed for the actual OBA procedure is not usually a problem.

However, Phillips has had problems getting reimbursed for associated fees.

The anesthesiologists had bought their own machine to use during procedures, she says. Weve had no problems getting reimbursed for the procedures, but we were not getting paid for the machine.

Because of that, Phillips physicians are scaling back on the number of OBA cases they perform for some specialties. We have no problems if the procedures are done in a freestanding pain clinic or other facility or practice that has its own equipment, she explains. These facilities have usually gotten their Medicare certification so Medicare and other big carriers will reimburse for services done there. And if the facility has its own equipment, it probably has an anesthesia machine that we can use instead of having to worry about using one of our own.

If the dentists we were working with had gotten their certification, they could have billed carriers at a higher rate and could have reimbursed the anesthesiologists for the machine we were providing, continues Phillips. But since they weren’t certified, the larger carriers wouldn’t pay us for the machine, and we weren’t getting enough reimbursement from the smaller carriers to make up for it. We didn’t feel it was worth doing that way. The result? The practice is selling its equipment and is focusing on providing OBA in settings that are already fully equipped.

Phillips recommends that anesthesia providers verify coverage for equipment used in non-hospital settings prior to making large investments in equipment that may be difficult to obtain reimbursement for. If the primary carriers will reimburse for the equipment, it may be a sound investment for the anesthesia provider.

Even with some of the problems associated with OBA, the option is likely to become more prevalent in the coming years, and reimbursement will hopefully get even easier. There are always some problems getting reimbursed for procedures or situations that are new, Phillips says. But if enough practitioners continue offering OBA, the reimbursement for services as well as equipment will eventually be on par with the procedure and the equipment necessary for it. Check with your local carrier to see what types of services and equipment theyll reimburse for.