Anesthesia Coding Alert

Do refills and follow-ups count?

Anesthesia and pain management practitioners don't perform E/M services as frequently as other specialists might, but you will have times when E/M codes apply.  Now that you know the basic criteria for reporting 99211, try your hand at applying the criteria to the following scenarios.  Scenario 1: A patient presents for a refill of a controlled substance (Demerol, Percodan etc.).  Solution: If the patient must be evaluated prior to the release of the prescription refill (and if that review could be performed by a non-physician) you could report 99211. If, however, the patient simply picks up a prescription being held at the front desk, you would not report anything for the encounter.
  Scenario 2: A patient comes in for a dressing change. The nurse documents swelling and redness around the incision site, takes the patient's temperature, cleans the area and re-dresses the wound. Solution: Yes, you can report 99211.
  Scenario 3: A patient comes to the office for her pre-op visit and has extensive questions about anesthesia, preparing for the procedure and what to expect during recovery. Pam Marshall, IS and contract specialist with Northern Colorado Professional Services in Ft. Collins, says some physicians want to report 99211 or 99241 (Office consultation for a new or established patient, which requires these three key components: a problem focused history, a problem focused examination; and straightforward medical decision making) for the visit in addition to billing the anesthesia, but this is not correct. Solution: The visit - no matter how many questions - is included in the anesthesia fee and is not separately billable.
  Scenario 4: A CRNA follows up with a patient in the 24-hour observation unit after his procedure. Solution: If the CRNA visit has anything to do with the anesthesia given earlier it is part of the postoperative check and covered by the global fee instead of qualifying for 99211.