Anesthesia Coding Alert

Question: The anesthesiologist was called to the waiting room, located directly outside of the operating room (OR) area, to assist a Medicare patient with acute respiratory distress. When the nurse called, the doctor was overseeing two OR rooms with CRNAs — the first case was a Medicare patient, and the second case was a commercial insurance patient.

The situation may be considered an emergency of short duration, and the geographical layout of the hospital allows the physician to remain in the immediate area outside of the OR. The two CRNA cases were documented as transfers of care to an anesthesiologist overseeing one room. Post-procedure documentation supports an emergency endotracheal intubation and a diagnosis of respiratory arrest. Was it appropriate for the anesthesiologist to assist the patient in distress, and if so, what diagnosis and CPT^® codes would you report?

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Answer: Yes, in this case, providing emergency assistance was appropriate. Although commercial policies do not typically address this exact situation other than to say they typically follow the Centers for Medicare & Medicaid Services (CMS) guidelines, CMS is considered a legitimate resource and does allow a medically directing anesthesiologist to address an emergency of short duration in the immediate area. Because the anesthesiologist documented a transfer of care for the two CRNA cases to another anesthesiologist who was overseeing one CRNA, services for all three anesthesia cases and the emergency intubation are billable.

For the emergency procedure, you would use 31500 (Intubation, endotracheal, emergency procedure).

Diagnosis roundup: The anesthesiologist documented a diagnosis of respiratory arrest, so you’d report R09.2 (Respiratory arrest). While your first instinct might have been to choose R06.03 (Acute respiratory distress), that would be incorrect, as that was not the final diagnosis. That’s why it’s essential to pay attention to the details. Plus, the post-procedure diagnosis of respiratory arrest (R09.2) is excluded per the Excludes1 note for R06.03.