Anesthesia Coding Alert

Question: Surgeons in our outpatient services department often request that an anesthesiologist consult with a patient during the pre-op visit. This may only be the day before the scheduled procedure, but is usually many days prior to it. Is the anesthesia consult billable? If so, what supporting documentation do we need?

Oklahoma Subscriber

Answer: Billing for a pre-op consult can be a gray area since the pre-op visit is part of the global anesthesia package. An anesthesia consult should not be routine, and must be more in-depth than an anesthesia evaluation before surgery. All patients go through a pre-op evaluation, which is why it is part of the anesthesia fee.

It would be virtually impossible to justify an anesthesia consult for a P1- or P2-level patient unless you can demonstrate that the service was drastically different and necessary, as opposed to a standard anesthesia evaluation.

If the consult is far in advance of the procedure and if it is requested for a reason other than something along the lines of "going to surgery," a code from 99241-99275 (E/M codes related to office or outpatient consultations, initial or follow-up inpatient consultations, or confirmatory consultations) could possibly be used since it is separate from the procedure's anesthesia. Select the most appropriate code from this group based on the individual circumstances. Document the reason for the consult (organ transplant candidate, multiple health problems with a complicated procedure, optimizing a severe COPD patient, etc.), and be sure the anesthesiologist sends a written report back to the surgeon.

Also remember that if the consult is performed well in advance of the procedure, the standard pre-op visit must still be completed for the anesthesiologist to meet the criteria for full service.