Anesthesia Coding Alert

Question: A patient arrives at the OR at 7:30 a.m. The anesthe­siologist places an A-line and central line, finishing at 8:15 a.m., with anesthesia induced two minutes later. I know you can bill for lines (36620, 93503), but does the anesthesia time start at 7:30 or after placement of the lines? Do you risk double-billing by reporting for both time and line placement?

California Subscriber

Answer: You should not report anesthesia time separately for the line placement. For billing purposes, the anesthesiologist’s time should begin at 8:16 (the minute after line placement ended).

If invasive line placement occurs after the patient is anesthetized, however, you don’t subtract the time spent placing the line from the total anesthesia time for the procedure. Rather, add the line placement (93503, Insertion and placement of flow directed catheter [e.g. Swan-Ganz] for monitoring purposes or 36620, Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) as a separate service in addition to the procedure’s anesthesia and time units. Your payer may require you to append modifier 59 (Distinct procedural service).

Remember: Check with the payer before deciding how you should report the service.