Anesthesia Coding Alert

Its not uncommon for patients to undergo many diagnostic or therapeutic procedures on an outpatient basis rather than as an inpatient. Coding for anesthesia during these types of procedures, such as radiation or an MRI (01922, anesthesia for non-invasive imaging or radiation therapy), is simple and reimbursement is straightforward if the services take place on different days. But some coders find that reimbursement can get much more complicated if a patient has multiple outpatient procedures on the same day. To optimize reimbursements, learn the requirements of your local carriers and use the appropriate modifiers.

If we schedule more than one procedure on a patient in the same day, its basically because of convenience, says Jan Wirtz, an anesthesia coder and owner of Specialty Billing Services Inc., a firm that specializes in anesthesia billing in Wacona, Minn. If the patient is already coming to the office, why not treat other problems or do other procedures during the same visit as long as medications dont pose a problem? That way the patient doesnt need to schedule additional appointments.

As convenient as that may be for the patient, Wirtz points out that its actually in the physicians financial interest to schedule procedures on separate days. Most insurance carriers have reimbursement guidelines that encourage physicians to schedule patients procedures on different days. Insurance companies will only pay half of their usual allowances for the second or third procedures done on the same day. If a doctor wants to get paid the full allowance, the procedures need to be done on different days, she says.

Multiple Billing Successes

Using modifier -59 (distinct procedural service) is the best route around the multiple procedure reimbursement problem, when it is appropriate, says Marilyn Wilson, billing manager with Southeastern Pain Management, an anesthesia practice in Gadsden, Ala. Medicare accepts it, and most other insurance carriers accept it now that its been in CPT for two years. Some carriers are slower than others updating or changing their policies, but we dont run into many problems using it these days. When we do have a multiple procedure reimbursement problem, its usually because we failed to include a modifier with one of the procedures.

When several procedures are being filed, base the claim on the highest unit procedure and use the total time associated with all the procedures to bill for them, Wirtz says. Two common scenarios include:

1. Placing an epidural catheter to help manage post-operative pain on the same day as general anesthesia: Code the surgery with the American Society of Anesthesiologists (ASA) code for the general anesthesia; 36489-59 (placement of central venous catheter; percutaneous; over age 2-distinct procedural service) for the central venous catheter (CVC); and 62319-59 (injection, including [...]