Anesthesia Coding Alert

One common question regarding line placement is whether medically directing anesthesiologists can bill for them. The answer is yes   if youre in certain states.
 
An anesthesiologist must meet seven criteria before submitting a claim as medically directed (known as CMS Seven Rules of Medical Direction). One of these rules states that an anesthesiologist may perform certain duties for other patients while medically directing cases. Six common services are listed, including addressing an emergency of short duration, administering an epidural or caudal anesthetic to a labor patient, and checking or discharging patients in the PACU. But what about other common services such as line placements for surgery?
 
Since placing lines isnt one of the six allowed services while medically directing, this has been a source of confusion and a very gray area for billers, says Kelly Dennis, CPC, EFPM, of Perfect Office Solutions in Leesburg, Fla. Some anesthesia societies and carriers have worked together to clarify this question so coding and reimbursement are consistent. 
 
For example, Georgias Medicare Part B carrier and the Georgia Society of Anesthesiologists practice management committee collaborated on this issue several years ago. They determined that the medically directing anesthesiologist may place lines and epidurals in the holding area, consistent with the CMS policy. As long as the medically directing anesthesiologist remains physically present and available for immediate diagnosis and treatment of emergencies, we would agree that the following procedures would be an illustrative but not exclusive list of allowed interventions, the announcement stated. The examples cited were placement of a Swan-Ganz catheter, central line or arterial line; placement of an epidural catheter for postoperative analgesia or in preparation for subsequent surgery (for a to follow case); and placement of other peripheral nerve blocks prior to subsequent surgery, including brachial plexus blocks, ankle blocks, femoral nerve blocks, etc.
 
Other states such as Florida have considered Georgias policy when establishing one of their own. Check with your local carriers to learn if they have written policies regarding line placements and medical direction, or to learn what their guidelines are.