Anesthesia Coding Alert

Question: The anesthesiologist placed a double lumen tube, a lung ventilation and fiberoptic intubation. May we bill for these along with the primary procedure with modifier -59 (distinct procedural service)? If so, what code would I use?

Washington subscriber

Answer: A double lumen tube is routinely placed for lung surgeries. It allows the anesthesiologist to inflate only the affected lung so that the operative side remains quiet for the surgeon. The anesthesiologist will often followup with a fiberoptic bronchoscopy to confirm correct placement of the bronchi. This procedure is the standard of care for such surgeries, and is covered by the base units (13-15 for the thoractomy) and the fact that the clock is running in regard to anesthesia time during the intubation. Most carriers, particularly Medicare, consider the double lumen to be included in the anesthesia fee. Some insurance companies (mostly private carriers) will reimburse for the procedure with fiberoptic intubation, however. You could code it as thoractomy with decortication (32220 decortication, pulmonary; total, or 32225 decortication, pulmonary; partial) and include modifier -22 (unusual procedural services).