Anesthesia Coding Alert

Question: When our anesthesiologist places a peripherally inserted central venous catheter (PICC), may I bill for it, or is it an included anesthesia service?

Florida Subscriber

Answer: When your anesthesiologist places a PICC, it is separately billable. If catheter placement allows access to the central venous circulation system, charges for insertion of these invasive monitors are not a part of standard anesthesia fees, according to the 2009 Relative Value Guide (RVG) base value section. This is true even though monitoring is included in the base value.

To make sure that your physician placed the PICC rather than provided anesthesia (00532, Anesthesia for access to central venous circulation) while the surgeon placed the PICC, look for two things: See if the anesthesia record is for another type of surgery, not PICC; and check the procedure notes comments section for an indication on the anesthesia record that the anesthesiologist placed the PICC.

Medicare carriers must pay for insertion of an a-line, CVP, and Swan Ganz catheter when an anesthesiologist performs them during an anesthetic. Insurance carriers may claim that you cannot be personally doing any other type of surgery while giving anesthesia and expect to double bill (get payment for anesthesia and the procedure).