Anesthesia Coding Alert

Question: Is there an appropriate way to bill an extubation? There is no CPT code, but the doctor spent more than 20 minutes with the patient. Would a subsequent hospital code 99231-99232 (subsequent hospital care, per day, for the evaluation and management of a patient; medical decision making is either straightforward/of low complexity or of moderate complexity) work?

Cathy Reifer
Anesthesiology Associates, Pittsburgh

Answer: Extubation is generally routine and is not billable. It does not require any special medical skills and non-physician providers (nurses, respiratory therapists, etc.) often do this. It is not stated in the question whether this is immediately postoperative, in an intensive care unit or elsewhere.

If 20 minutes were spent extubating a patient in the recovery room after surgery, this could be considered anesthesia care. After appropriate documentation of the exam, medical decision-making, and rotation of the patient's condition in the anesthesia chart, this time could be billed even if it was not immediately contiguous to the anesthetic. Discontinuous anesthesia time is now permitted, so extubation could be viewed as a resumption of anesthesia care. Medicare will not pay for services provided in a postoperative anesthesia care unit (PACU) by an anesthesiologist with codes 99231 or 99232.

If this extubation was not associated with operative care, then an appropriate E/M code reflecting what the patient's problems were and the interventions performed for 20 minutes (with extubation being just one) is warranted. Something more was going on if an anesthesiologist was present for the extubation and for an additional 20 minutes. It is for these other reasons (those that required medical judgment and expertise) that a bill should be generated.