Pre-anes consults
It's going to depend on how they document.
Most of the Pre-Anesthesia consults that I see are simply pre-anesthesia exams. However, ASA and CMS is quite clear about the MDAs & if they do work that's above & beyond the usual anesthesia exam, then you can bill for the consult.
Be VERY careful, though - make sure that the documentation supports the need for an anesthesia consult. I reviewed a stack of 50 OB consults & found that less than 3 actually went above & beyond the norm (not routine) and were billable. Just seeing if the patient is a good candidate for labor epidural doesn't count, IMHO. It's part of the pre-anesthesia plan of care & can't be billed.
Someone got it into their heads that if they set up a pre-anesthesia clinic and had patients visit it approximately 1-2 months prior to the surgical procedure, they would have more compliance from the patient. Some hospitals put the administration of such a clinic into the contracts of anesthesiologist groups and left it to them to support it financially. The trouble is - the anesthesiologists and/or PAs involved are doing the minimal surgery clearance for anesthesia and the documentation didn't support medical necessity. Extra work, MDM, diagnostic testing wasn't in the chart notes because it wasn't needed. True, there were fewer no-shows on the day of the procedure, but the anesthesiolgist groups couldn't bill for what is essentially considered part of anesthesia services.
See if these links help - they should be good until ASA moves the links again (I swear, they're worse than CMS ever was in that regard!)
Pre-operative Visits - Should I bill for them?
If ASA moves the link again (or if the above doesn't work) It's here:
https://groups.yahoo.com/neo/groups/csen-anesthesia-mailing-list/conversations/topics/15397?var=1
Codapedia article - not dated (hate when these blogs don't date their stuff!)
Do your research; generally speaking the pre-anesthesia consult is included with the anesthesia services, whether 1 month before the surgery or 1 day. The question that needs to be asked and then answered by the documentation is: what's the medical necessity for this?
IF there is sufficient documentation that shows the MDA going beyond the usual, routine type of exam for a patient, then the consult may be billable.
Good luck!
Leslie Johnson, CPC
