Anesthesia Coding Alert

Question: Carriers frequently bundle our A-line placements into the primary procedure. What should our anesthesiologists write on their charts to document that A-line placements are separate procedures?

Nebraska Subscriber

Answer: Your anesthesiologist should document the procedure in the first person, such as, "I placed A-line" to show that he personally placed the line. Some carriers also request documentation that shows where the physician placed the line, why he placed it (not simply for routine monitoring), and the time he spent placing it (if it's in the record). Some carriers stipulate that you must include start and stop times because the line placements are surgical procedures. Because CRNAs often place the line, it's particularly important that your documentation demonstrate that the physician personally placed the line and didn't simply provide supervision.

Be sure that your carrier processes your claim based on the anesthesia code instead of the procedure's surgical CPT code. Carriers that base claims on the surgical code often deny the A-line as included in the surgical procedure. Also check whether the surgeon billed for a line placement on the same date. Anesthesiologists often replace lines that aren't working correctly, and if this is the case, your physician's documentation should clearly state that he replaced the line. This way, your carrier will reimburse it separately from the surgeon's line placement.

If you still experience denials, send the carrier copies from the ASA Relative Value Guide about invasive monitoring techniques. This clearly states that A-line placement is not the norm for all patients and as such is separately payable.