Anesthesia Coding Alert

Be alert for situations that require ABNs -- and those that don't

      Sometimes you need to file an ABN for services that might not normally need the extra paperwork. Watching all the details of a patient's care will tip you off, especially when you're coding for injections.

      Consider these examples from Neil Busis, MD, with the University of Pittsburgh Medical Center in Shadyside, and Scott Groudine, MD, an anesthesiologist in Albany, N.Y., of when you might need an ABN:

      Example 1: A Medicare patient requests anesthesia for his upcoming screening colonoscopy. The catch: The patient does not have any of the co-existing conditions the local Medicare carrier's LCD (local coverage determination policy) requires for anesthesia during a colonoscopy. Consequently, the carrier will likely deem any charge for anesthesia as medically unnecessary.

      What you do: Ask the patient to sign an ABN outlining the services your anesthesiologist will provide (anesthesia during the colonoscopy procedure) and the reason Medicare might reject payment (considers anesthesia medically unnecessary). You report 00810 (Anesthesia for lower intestinal endoscopic procedures distal to the duodenum) and append modifier GA.

      Example 2: A patient with muscle spasm (728.85) requests a botulinum injection to combat his symptoms. The catch: This patient received a chemodenervation injection six weeks ago. Medicare often limits botulinum treatment frequency and will not pay for additional injections during a given time period without evidence of extenuating circumstances.

      What you do: Because you are unsure whether Medicare will cover the procedure, ask the patient to sign an ABN. The ABN outlines the service the physician will provide (Botox injection to treat blepharospasm) and the reason Medicare may reject payment (excessive frequency). You report 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) and append modifier GA.

      Example 3: A patient with chronic lower-back pain requests an epidural injection. The catch: This patient has already had six such injections in the past 12 months -- the maximum number his Medicare carrier will reimburse in a one-year period without extenuating circumstances.