4 Important Items You Don't Want to Miss In the Anesthesia Record

Extra units for reimbursement might be lurking in places other than the charge ticket.
Anesthesia coders have an edge over co-workers in other specialties: you have more resources when it's time to comb through charts for all the info you need. Use that access to the anesthesia record, charge ticket, and surgical report to find every detail that might help you in achieving medical billing and coding accuracy.
Unique challenge: A lot of practices use a charge ticket along with the anesthesia record. Many times, inconsistencies occur when information is transferred from the anesthesia record to the charge ticket. It's vital to compare the charge ticket to the anesthesia record, to ensure all key components are accounted for.
Read on for important medical billing and coding information you must focus on in your provider's anesthesia record.

1. Line Placements
Line placement is one service you can code together with the anesthesia service, so don't miss that chance.
Watch for notes concerning Swan-Ganz catheters (93503, Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes), arterial lines, CPT codes 36620-36625 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; …), or central venous catheter placement, CPT codes 36555-36571. Your provider must also evidently document the line's purpose, like additional monitoring or for use in postoperative pain management prior to the procedure.

2. Diagnosis and Procedure
You should know the procedure being carried out in order to select the accurate anesthesia code. General information concerning the patient's diagnosis and any past or present health conditions that can affect the procedure might change your coding.

Here's why: Conditions like hypertension, past coronary or pulmonary problems, or chronic diseases can escalate the anesthesiologist's risk or help explain the need for anesthesia. For instance, the anesthesiologist might need to take extra precautions during surgery on an obese patient with hypertension. A diagnosis of claustrophobia or Parkinson's can support medical necessity for anesthesia during "standard" procedures like an MRI.

3. Type of Anesthesia
Did the physician or CRNA offer general anesthesia, a regional, or observed anesthesia care (MAC)? The answer to this medical billing and coding question can definitely affect your coding, for instance when you need to append modifier G8 (Monitored anesthesia care [MAC] for deep complex, complicated, or markedly invasive surgical procedure) or G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition) to the claim.

4. TEE, Fluoro, BIS Monitoring
You can sometimes distinctly report other services the anesthesiologist delivers during the procedure. Watch for documentation of these, including:

• Transesophageal echocardiography (TEE) probe placement (93313, Echocardiography, transesophageal, real-time with image documentation [2D] [with or without M-mode recording]; placement of transesophageal probe only). Ask your providers to specify "monitoring" or "diagnostic" when they use TEE so you can code appropriately.
• Fluoroscopic guidance for blocks or catheters used to provide postoperative pain management or placement of a central venous or Swan-Ganz catheter. These services are signified by CPT codes like 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) and +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]).