Anesthesia Coding Alert

Question: The anesthesiologist provided emergency anesthesia services to a 47-year-old Medicare patient who has multiple comorbidities and a severe systemic disease. The patient had multiple procedures performed. The first procedure was a thromboendarterectomy of the carotid artery. During surgery, the patient required placement of both an arterial line and a nontunneled central venous catheter. There are separate procedure notes for the arterial line indicating the anesthesiologist placed the line after induction of anesthesia to monitor the patient’s blood pressure. Under sterile conditions, the arterial line was advanced through an introducer sheath into the right radial artery. Using the Seldinger technique, the central line catheter was advanced through the introducer sheath and into the subclavian vein using ultrasound guidance. Ultrasound guidance was used to evaluate the potential access site with real-time visualization of vascular needle entry and permanent recording by retrievable image. The procedure notes are signed by the anesthesiologist, and the anesthesiologist personally performed all services.

Which surgery code crosswalks to an anesthesia code in this scenario? What is the appropriate anesthesia procedure code and modifier? Are there additional services I might report?

Florida Subscriber

Answer: The appropriate surgery code for the thromboendarterectomy is 35301 (Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision).

This surgical code crosses to anesthesia code 00350 (Anesthesia for procedures on major vessels of neck; not otherwise specified). Because the anesthesiologist performed all of the anesthesia services, you should append modifier AA (Anesthesia services performed personally by anesthesiologist).

There are three additional services you may report:

• Arterial line placement: 36620 (Arterial catheter­ization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous)
• Central line placement: 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older)
• Ultrasound guidance: +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure))

Medicare does not allow additional payment for emergency code +99140 (Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure)) or modifier P3 (A patient with severe systemic disease).