You can use Monitored Anesthesia care for those CPT codes in Appendix G under certain circumstances.
For example:
- the provider of anesthesia services has to be different than the surgeon.
- the type of anesthesia must be either MAC (monitored anesthesia care) or GA
- For many carriers, there must be some kind of reason that justifies the need for anesthesia services (provided by another MD/CRNA). This reason is usually in the form of some kind of co-morbid condition that makes doing the procedure unsafe or harmful for the patient to go through under "ordinary circumstances".
As you well know, you aren't going to get a 2-year old baby to stay still long enough to insert a PICC line - you need them sedated - deeply! and again, as you well know, you need to have an independent trained observer because of the depth of sedation required. But like you said, how deep is "deep"?
I use this table here to educate the others about the levels of sedation & the codes that go with them:
http://www.asahq.org/publicationsAndServices/standards/20.pdf
The the first column, minimal sedation is more than likely not billable or inclusive with the procedure - like giving a patient a valium or benedryl to make them sleepy but they're still "there"; the 2nd column is more like the 9914x series of codes; last two columns on the left are where you'd use anesthesia codes - deep sedation/GA;
Re: Your example:
Insertion of a PICC line 36568 billed with 47 modifier and then in addition billing the 00532 for the anesthesia as well.
If/when you bill that way, you're telling the insurance companies this scenario:
The surgeon who is inserting the PICC is giving anesthesia/sedation to the patient (36568-47 - billed by the surgeon), a CRNA or anesthesiologist is also providing anesthesia services for the surgeon (00532 - billed by the CRNA or Anesthesiologist). This will never happen UNLESS the surgeon's anesthesia/sedation didn't take and a CRNA or anesthesiologist was called in to provide something deeper.
A surgeon will never bill using anesthesiology codes, either. They are strictly CPT/HCPCS. However, it's possible for an anesthesiologist to use both the CPT and Anesthesia codes (that's another LONG story).
So, in direct answer to your question (don't you wish this was just oh, so simple?): YES, for CPT codes in Appendix G, anesthesia services by an anesthesiologist/CRNA can be given to a patient, yes they can be billed & yes, you can get paid for them - IF those conditons apply and IF you code/bill them out correctly.
Leslie Johnson, CPC
http://www.askleslie.net