Anesthesia Coding Alert

Question: One anesthesiologist in our group routinely goes to the pre-op area to insert lines (Swan-Ganz, A-lines, CVPs) while he is supervising CRNAs. Can he bill for the time spent inserting the lines?


Florida Subscriber

Answer: Select the appropriate code from 36555-36571 for the CVP insertion, depending on the patient's age, whether the catheter is tunneled or non-tunneled, and whether it includes a subcutaneous port or pump.
 
Report 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) or 36625 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; cutdown) for the arterial line and 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) for the Swan-Ganz catheter.

According to Florida Medicare, a physician can place lines while medically directing cases and not break the medical-direction requirements. Because line placement is a surgical service paid on a flat-fee basis, you do not report or bill time separately.

The anesthesia record's documentation of line placements should be clear, especially if there's a need for more than one line. The record should also indicate who actually performed each line placement.