Anesthesia Coding Alert

Question: What are the minimum documentation requirements to be compliant with reporting the patient’s anesthesia prep time? Considering the Centers for Medicare & Medicaid Services’ (CMS’) definition of anesthesia start time as preparing the patient for the anesthesia services, if the anesthesia provider is only performing a review of the patient’s chart, can that be considered compliant for documentation purposes, or should there be other functions or elements to consider besides a review of the chart? The information I’ve found in the CMS processing manual does not clearly explain this situation. How would this scenario be billed/ considered?

Arizona Subscriber

Answer: According to CMS guidelines, anesthesia start time begins when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room (or in an equivalent area).

Anesthesia time ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision or another caregiver. The anesthesia care during the procedure includes the administration of fluids and/or blood and the usual monitoring services (e.g., ECG, temperature, blood pressure, oximetry, capnography, and mass spectrometry).

Based on these guidelines, only performing a chart review is not sufficient to code the service and is already considered in the base value for the service performed. This time is NOT separately reported.

And also remember that a few forms of monitoring (e.g., intra-arterial, central venous, and Swan-Ganz) can be billed separately because they are not included in the anesthesia time or base value. Examples of a few codes you can report for these services include:

• 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older)
• 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous)
• 93503 (Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes)