Anesthesia Coding Alert

Question: I have two scenarios I'd like advice on. First, how should I code a procedure if one anesthesiologist inserts the lines but another anesthesiologist administers the other anesthesia services? Second, how should I code when one physician inserts the lines and begins anesthesia administration, but a second anesthesiologist finishes the case?

Oregon Subscriber
 
Answer: For the first scenario, code each service in the name of the physician who performed it. For example, if one physician inserted the line, report 36489* (Placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous, over age 2) in his or her name (unless the patient was under age 2, in which case you'd report 36488*, ... percutaneous, age 2 years or under). Then bill the anesthesia service in the name of the physician who performed the anesthesia. Append modifier -59 (Distinct procedural service) to the line-placement claim to indicate that it was separate from the procedure's anesthesia. Report the physicians' work on separate claims so the carrier understands how the case was handled. Include notes in Box 19 stating that the remainder of the procedure (either line placement or anesthesia) is on a separate claim form.
 
Deciding how best to report your second scenario - known as a shared case - is an ongoing issue with no federal rules or regulations to follow. Some practices bill by the physician who started the case, others bill by who ended the case, and others bill by the physician who was involved with the case for the longest period of time. Individual carriers may have their own policies, but many follow the guideline of reporting the case under the physician who inserted the lines. You can report the entire case on one form, but include the beginning and ending times for both physicians in Box 19. For example, "Dr. Adams: 0700-0815; Dr. Brown: 0815-0900." Remember to bill for the total number of time units for both physicians. Keep an internal memo on the case so you can divide the payment appropriately.