Anesthesia Coding Alert

Question: Our anesthesiologist placed an emergency endotracheal tube while the patient was under MAC (monitored anesthesia care). Should we bill for the intubation?

Pennsylvania Subscriber
 
Answer: The answer depends on the circumstances surrounding the emergency intubation. If the surgeon placed the tube in the OR during a MAC procedure because the patient had breathing problems, then the procedure converts to a GA (general anesthesia) case and regular anesthesia codes apply. The intubation would become part of the procedure's anesthesia, and you could not code it separately. In this case, you would no longer report a MAC modifier to carriers that require them for strict MAC cases.

If the patient develops breathing problems and requires intubation while in the recovery room, you might be able to bill for emergency intubation, depending on the circumstances. The key is determining whether the anesthesia provider has already relinquished care following surgery. If the patient required intubation upon his arrival in the recovery room, do not code for it, because anesthesia time has not ended and the service is included in the time units of the anesthesia itself.

Coding for the intubation as a separate service might be appropriate, however, if the anesthesiologist was no longer in personal attendance and the patient was safely placed under postoperative supervision before problems began. In this case, anesthesia time from the original procedure ended before the anesthesiologist placed the tube, so you could bill 31500 (Intubation, endotracheal, emergency procedure). Append modifier -59 (Distinct procedural service) if the report supports a "separate and distinct" service.

You can also bill 31500-59 if the patient develops breathing problems after the physician releases him to his room (although if it's the anesthesiologist's "fault" that the patient needs intubation, it might be more prudent from a medical/legal standpoint to correct the problem free of charge). If you do report the service, submit a paper claim  explaining the situation, including thorough documentation of the change in patient status that required the physician to change the original MAC anesthetic plan.