Anesthesia Coding Alert

Question: The anesthesiologist intubated a patient, performed ventilation assistance/management, and provided anesthesia during an open procedure on the patient’s ankle bone. The patient was covered by Medicare and all services were completed on the same day. Can we bill for everything since the services are so different from each other?

Idaho Subscriber

Answer: According to Correct Coding Initiative edits, codes 31500 (Intubation, endotracheal, emergency procedure) and 94002 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day) both are considered part of the anesthesia service for 01480 (Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified). That means you shouldn’t normally bill for the services on the same claim. However, you might be able to bill separately under certain circumstances, such as when the physician performs an emergency intubation outside the anesthesia service.

Explanation:  Consider the explanation of bundled services from the CCI manual. “94002-94004, 94660-94662 (Ventilation management/CPAP services): If these services are performed during a surgical procedure, they are included in the anesthesia service. These services may be separately reportable if performed by the anesthesia practitioner after post-operative care has been transferred to another physician by the anesthesia practitioner. Modifier 59 may be reported to indicate that these services are separately reportable. For example, if an anesthesia practitioner who provided anesthesia for a procedure initiates ventilation management in a post-operative recovery area prior to transfer of care to another physician, CPT^® codes 94002-94003 should not be reported for this service since it is included in the anesthesia procedure package. However, if the anesthesia practitioner transfers care to another physician and is called back to initiate ventilation because of a change in the patient’s status, the initiation of ventilation may be separately reportable.”