Anesthesia Coding Alert

 These 3 steps lead to success

The fees for global anesthesia codes include most of the services that anesthesiologists normally perform - unless you're dealing with exceptions such as some post-operative care situations.
 
Most coders count out separate payment for post-operative pain management (01996, Daily hospital management of epidural or subarachnoid continuous drug administration), but there are circumstances when you can be paid for these services. Perform these three steps to work your way toward separate payment for 01996.

1. Get the Request in Writing

Most of the time, the surgeon is responsible for a patient's postoperative pain management. But if he requests special post-op care by the anesthesiologist, get the request in writing to bolster your case for proper reimbursement.
 
"Our office kept a log of the requests we received from surgeons for postoperative pain management to help us track things," says Kelly Dennis, CPC, ACS-AP, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla. "It's also good to have the anesthesiologist make note of the surgeon's request to ensure that documentation in the patient's chart is in line with the surgeon's order."
 
Dennis points out, however, that the need for an anesthesiologist to provide post-op care should be determined patient-by-patient. "These should not be done on a routine basis," she says. "For example, the surgeon can't say, 'I need post-op pain management for all of my hip surgery patients.' The surgeon needs to consider the circumstances of each case."
 
Some anesthesiologists ask that the surgeon officially request a pain consult. This includes a signed order and reason for consultation, which provides the anesthesiologist with an adequate written request and indication for care.
 
What if you don't have the request in writing? All is not lost, but encourage the anesthesia provider to document everything as clearly as possible to help your chances of appropriate reimbursement. According to the ASA's Practice Management Compliance with Medicare and Other Payor Billing Requirements, "In the absence of a written request, the anesthesiologist should document who made the request, when it was made, and why, as well as noting the anesthesiologist's own treatment of the patient in detail."

Reminder: You cannot bill 01996 for the day the physician places the epidural or subarachnoid catheter. Report it for any follow-up days of care.

2. Report the Correct Type of Service (TOS)

Post-op pain management is a medical care procedure instead of an anesthesia service. As such, report it as type of service 02 (Medical care) instead of the usual 07 (Anesthesia service). Remember: Because you're reporting a medical service, you don't report time units associated with the procedure as you do for anesthesia care.
 
Be sure to submit claims with the correct service listed for the correct physician. The same physician might provide anesthesia during the procedure and then handle all of the patient's post-op care, but the services might also be shared between providers. If several providers participate in the patient's care, submit different claims for each service.
 
"If you're filing a paper claim and the same physician provided both services, you don't need to file a separate claim for each," Dennis says. "The different types of service listed and modifier -59 (Distinct procedural service) appended to the post-op management will identify the separate service distinctions."
 
Note: Only report modifier -59 on the day of the original procedure and the start of post-op pain management. You do not use it for subsequent days of care, says Barbara Johnson, CPC, MPC, president of the consulting firm Real Code Inc., in Moreno Valley, Calif.

3. Clearly Document the Catheter Placement

Carriers reimburse the provider who places and monitors the line used for post-op pain medication administration, if it is documented. Marking a checkbox on the patient's record is not enough documentation to support this requirement, Dennis says. That's because you're calling it a separate and distinct service by using modifier -59, so you need documentation of the reason for placement as well as details related to all aspects of the catheter placement: