Anesthesia Coding Alert

Question: Can I report the IV start for PCA (patient-controlled anesthesia)? Our physician consulted with a patient following laparoscopic bypass surgery before starting an IV PCA. The anesthesiologist returned the next day to check the patient and discontinue the PCA. How should I code this case?

Arkansas Subscriber

Answer: It looks as if you have three different issues to consider coding: the PCA and IV start, the initial consult, and the follow-up care.
 
Some carriers reimburse for PCA, but others (such as Medicare) do not. Begin by verifying the carrier's policy regarding PCA payment so you can code according to those guidelines.
 
Some carriers require 01999 (Unlisted anesthesia procedure[s]) for PCA; others require 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem-focused interval history; a problem-focused examination; medical decision-making that is straightforward or of low complexity).

You can bill for the initial consult if you have the documentation to support it. The anesthesiologist did not admit the patient, so consult codes 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ...) do not apply. Instead, select from initial inpatient consultation codes 99251-99255 for the first day and 99231 for the following days.

Chances are the IV start is bundled with the initial consult (Medicare, for example, bundles the IV start). That  means you wouldn't code separately for it, but verify this with the carrier as well. If the carrier allows you to bill both services, append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the consult code.