Part B Insider (Multispecialty) Coding Alert

Your carrier may require modifier 59

Myth: You can never bill separately for arterial lines (A-lines) if your doctor is already providing global anesthesia services.

Reality: You can bill for A-lines (36620 and 36625) separately when the anesthesia provider places the line, says Kelly Dennis with Perfect Office Solutions in Leesburg, FL. 

The American Society of Anesthesiology-s statement on intravascular procedures says that placement of an arterial catheter (36620) should never be included in the global anesthesia fee, notes Karen Glancy, director of coding with Anesthesia Management Partners in Chicago. Also, Medicare's Correct Coding Initiative policy manual on anesthesia indicates 36620 is not a bundled service, she adds.

Exceptions: In some locations, other clinical personnel may place the A-line, Dennis notes. In that case, the medical record should note which provider actually placed the line. The A-line may also be in place when the patient begins surgery, in which case the record should say the line was -in situ,- or already in place.

Different practices and facilities may have their own policies on when a patient should receive an A-line, notes Dennis.

Modifier: If your carrier insists on denying the A-line as part of the global anesthesia package, you can attach modifier 59 to identify it as a separately billable service, Dennis adds. Some local carriers have policies which specifically call for modifier 59 on A-line claims.

Documentation: Include the name of the physician or Certified Registered Nurse Anesthetist (CRNA) who placed the line; a description of the procedure, including the location of the line and the size of the needle; and complications, if any, says Dennis.

Check with your carrier: See if your physician can place an A-line while providing medical direction, Dennis advises. (For example, Florida Medicare says in a Q&A that a physician can place an A-line without violating the rules on medical direction.)

In the case of medical direction, the attending anesthesiologist must be -elbow-to-elbow- with the CRNA or resident who places the A-line, says Glancy. That means the attending anesthesiologist must be present and directing the line placement.