Anesthesia Coding Alert

Question: What should we do to get paid for codes 61624 and 36491? This payer requires surgical instead of anesthesia codes and requires justification of the anesthesiologist's necessity.

New York Subscriber

Answer: Code 61624 (Transcatheter permanent occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method; central nervous system [intracranial, spinal cord]) is 10 units, and 36491* (Placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; cutdown, over age 2) is 4 units. Anesthesiologists are rarely needed for 61624, so justifying the medical necessity isn't unexpected. The surgeon's notes should state the reason for the anesthesiologist's presence in the case (such as conditions including mental retardation [317-319], Parkinson's disease [332.x], or cerebral palsy [343.x, 437.8, 438.x]).                                         

 Anesthesiologists often provide anesthesia while the surgeon inserts a Hickman or Mediport cath (36491). Be sure you're coding the anesthesiologist's central venous pressure (CVP) line placement instead of reporting the surgical code itself. Code 36489* (Placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous, over age 2) is most often used for CVPline placement (percutaneous placement, not cutdown as with 36491). If the anesthesiologist provides anesthesia for a Hickman or Mediport catheter insertion, bill 4 units plus time.