Anesthesia Coding Alert

Question: How should I code a preoperative visit conducted by the anesthesiologist or CRNA? This is usually on a different day from the surgery and is usually not performed by the provider who will handle anesthesia during the procedure. Should I report the appropriate E/M code, or the anesthesia CPT code along with the time spent with the patient or in the pre-op clinic?

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 Answer: The basic values for anesthesia procedures include the presurgical anesthesia evaluation, so this time spent with the patient is not usually separately billable.  But sometimes, separate billing may be appropriate. One instance is if the evaluation was more extensive than routine. For example, the anesthesiologist might evaluate a patient with pheochromocytoma and prescribe medications for the patient to take until certain criteria are met that make him more suitable for anesthesia during surgery. The patient returns for a second anesthesia evaluation once the criteria are met, and surgery is performed. The anesthesiologist reports the appropriate E/M code for the first visit but does not charge for the second visit because its part of the pre-surgical evaluation.
 
In another scenario, the surgeon might postpone a case because the patient has complications prior to surgery such as a sudden rise in blood pressure. Most anesthesia providers still treat the presurgical evaluation as part of the procedures anesthesia and dont bill for it. But if the case is delayed for several days and the physician or CRNA conducts a second anesthesia evaluation, many coders believe it is appropriate to bill the initial evaluation with a code from 99221-99223 for an inpatient evaluation or 99201-99215 for an outpatient evaluation. Guidelines for this can vary, so check whether your group or facility has policies to help you make the call.