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Anesthesia Coding Alert

Test Yourself:

Base Charging for Consult and Epi Patch Placement on Several Circumstances

Published on Tue May 17, 2005

Key: Verify vital details with the anesthesiologist before coding the case

Look at the entire situation to determine the medical necessity of a consultation and whether you should charge for both the consultation and epi blood patch placement. Consider these scenarios from South Carolina coding consultant Julee Shiley, CPC: 
 

  • Scenario A: A surgeon or emergency-department  physician determines that the patient needs an epidural blood patch and asks the anesthesiologist to administer it. This does not qualify as a consult, so you only report 62273 (Injection, epidural, of blood or clot patch) for the epidural patch. 
     
  • Scenario B: An anesthesiologist provides spinal or epidural anesthesia during a procedure. Afterward, the patient needs an epidural blood patch due to a complication of anesthesia service. If the same anesthesiologist (or another anesthesia provider from the same group) administers the patch, this would be considered "consulting yourself," which would be inappropriate. Therefore, only report 62273 for the blood patch.
     
  • Scenario C: An emergency-department physician, surgeon or other referring physician/provider seeks the anesthesiologist's advice on whether an epidural blood patch might be beneficial. If all consultation criteria are met and the anesthesiologist communicates back with the referring physician, you can report a consultation.

    If the blood patch is administered, report 62273 and append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate consultation code (from 99251-99255). If the anesthesiologist determines that the blood patch will not be beneficial, only report the consultation code.

    Bottom line: Read the referral carefully, says New Jersey coding consultant Jann Lienhard, CPC. If it asks the anesthesiologist to "consult and treat" the patient, then she says billing a consult would be fine. But if it asks the anesthesiologist to "treat and follow," Lienhard says this would be a new patient or established patient visit instead of a consult.

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