Anesthesia Coding Alert

Question: I have a couple of anesthesiologists that perform OB consults for patients who have complicated health histories and/or problems with prior deliveries. The consults are requested by the patient’s OBGYN and can be done anywhere from a week to a month before delivery of the baby to assess if the patient is a candidate for an epidural during labor. Are these OB consults billable separately or are they considered a part of the pre-anesthesia evaluation? 

Oregon Subscriber 

Answer: The correct answer will depend on how the anesthesiologists document the service. 

Most pre-anesthesia consults are simply pre-anesthesia exams that include the typical care included in the anesthesia code you report later. However, the American Society of Anesthesiologists (ASA) and CMS are quite clear about medically directing anesthesiologists (MDAs) and that if they do work that’s above and beyond the usual anesthesia exam, you can bill for the consult. 

Caution: Be very careful to ensure that the documentation supports the need for an anesthesia consult. Just seeing if the patient is a good candidate for labor epidural doesn’t count as a consultation. It’s part of the pre-anesthesia plan of care and can’t be billed.

Bottom line: Do your research before submitting a separate claim. Generally speaking, the pre-anesthesia consult is included with the anesthesia services, whether one month before the surgery or one day. The question that needs to be asked and then answered by the documentation is: what’s the medical necessity for this? If there is sufficient documentation that shows the physician goes beyond the usual, routine type of exam for a patient, then the consult may be billable. If so, you’ll choose from codes 99241-99245 (Office consultation for a new or established patient, which requires these 3 key components …).