Anesthesia Coding Alert

Question: My anesthesiologist wants to bill for IV placement in this scenario: Sometimes patients are in labor and delivery without an epidural. If the nurses can't get an IV placed, the OB physician orders an anesthesia consult for difficult IV access. Can we bill for an IV placement and epidural if needed hours later?

Tennessee Subscriber

Answer: You can bill only for the epidural placement, not the IV. The IV will be included in the global anesthesia fee. If you bill an IV and an anesthetic on the same day, it may appear as if you are unbundling bundled services.

The Correct Coding Initiative (CCI) edits state, "Physicians should not unbundle the anesthesia procedure and report component codes individually. For example, introduction of a needle or intracatheter into a vein (36000), venipuncture (36410), or drug administration (90760-90775) should not be reported when these services are related to the delivery of an anesthetic agent." If your physician starts an IV in a patient that does not receive an anesthetic, many insurers will not pay unless there is documentation to show that a physician's skill was needed. Medicare will not pay for starting an IV that is not a central line. If your insurer does pay for starting a peripheral IV, the correct code is 36000 (Introduction of needle or intracatheter, vein).