Anesthesia Coding Alert

Question: I have an anesthesiologist asking if a pre-op history and physical could be separately reimbursable on the same day of the procedure. He is being asked to perform this due since podiatry practitioners do not have the training/ qualifications to perform a complete history and physical in his state. The anesthesiologist believes he should be able to receive separate reimbursement for this since it is over and above the normal pre-exam he would perform for any other type of case. One coder advised me to add 15 minutes prior to anesthesia start time to capture one additional unit for the extra pre-op work. However, I do not believe this is a compliant action and could also be a documentation issue.

Do you think applying modifier 22 to the claim with the necessary documents requesting one additional unit of service is appropriate?

Arizona Subscriber

Answer: No, you cannot append modifier 22 (Increased procedural services) in this situation and expect additional reimbursement under most circumstances. You are correct in your thinking: Under no circumstances should the coder add time to either the beginning or end of the anesthesia case.

Here’s why: The patient’s pre-anesthesia assessment is included in the base value for all anesthesia services provided, which means under no circumstances can additional time be added to capture units related to pre-operative work. Although the physician believes he should be able to receive separate payment, unless he specifically contracts with an insurance carrier for separate payment, you shouldn’t bill the service separately.