Anesthesia Coding Alert

Question: My anesthesiologist inserted an arterial line in pre-op holding in preparation for the patient's surgery. The anesthesiologist indicated he spent a total of 17 minutes inserting the monitoring line. His anesthesia record indicated that the anesthesia start time was 30 minutes later. Can I bill for the A-line insertion separately or should I just include it with the global anesthesia fee?

Georgia Subscriber

Answer: You should consider the placement of monitoring lines, such as arterial lines, central venous lines, and Swan-Ganz catheters separately reportable from the anesthesia service.

You can count on separate reimbursement for A-lines if the physician clearly documents the placement. In this case, you would report 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) as a surgical service, which carries a base value of three units. In rare cases when a cutdown is required to place the line, you would report 36625 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; cutdown), which would yield five base units.

Warning: You'll also want to check with your payer to be sure they don't require you to append modifier 59  (Distinct procedural service) to 36620 or 36625. Doingso separates the line placement from the procedure's anesthesia service.

Be aware that some payers will simply pay a flat fee  using base units as mentioned above, rather than using time as a factor. Learn your payers' A-line policies and you'll be in a position to submit cleaner claims that get paid more often.

Note: According to CPT, since the A-line was placed before the start of anesthesia, the time required to place it should not be included with the total anesthesia time. Monitoring the line placement is considered to be separate and distinct from the anesthesia service.