Anesthesia Coding Alert

Question: Our anesthesiologist spent several hours providing anesthesia for a surgical procedure. The carrier says the procedure was not medically necessary, and will not reimburse for it. Where does that leave our anesthesiologist? Can he still be reimbursed for his services even if the surgeon is not? What type of documentation might we need to justify reimbursement?

Missouri Subscriber

Answer: In this case, the coder and provider should appeal to the carrier on the grounds that the anesthesiologist has no control over what procedures are scheduled, and that he or she properly anesthetized the patient. Sometimes insurance carriers pay, and sometimes they don't. If the carrier won't pay, the anesthesiologist should bill the patient since it is ultimately his responsibility to pay or get the carrier to pay. Including a diagnosis that indicates why anesthesia was requested may help in getting payment. A letter or brief written statement from the surgeon about the patient's condition can also help document why anesthesia services were rendered.

Answers to Reader Questions and You Be the Coder provided by Robin Fuqua, CPIC, anesthesia coder for Jose G. Veliz, MD, an anesthesiologist in Escondido, Calif.