Anesthesia Coding Alert

Question: A CRNA performed a consult history and physical within 30 days of the planned surgery. She chose to report code 99244 for the service. I was told that a CRNA could not report a code any higher than 99241 because the higher codes are reserved for physicians, physician assistants, and nurse practitioners. How should we handle this?

Vermont Subscriber

Answer: The issue at hand is not whether the certified registered nurse anesthetist (CRNA) is eligible to bill 99244 (Office consultation for a new or established patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity). The better question is, why is the CRNA billing a consultation at all?

A pre-operative examination is part of the anesthesia care package and is not usually seen as separately billable. Unusual circumstances might call for additional billing, but that is in rare cases.

In addition, before coding for a consultation, another provider must request this CRNA’s opinion regarding a problem that the provider needed a specialist’s assistance to manage. A consultation with a specialist in anesthesiology would normally be for a particular kind of specialized treatment, such as advanced pain management, and would not be requested for purposes of planning surgery. An anesthesiologist’s evaluation of a patient prior to surgery, in and of itself, is not a consultation, and not a billable service.

Bottom line: Unless you have documentation supporting the criteria necessary to bill a consultation, the pre-op evaluation is not separately billable from the standard anesthesia service.