Sunday, March 20, 2011

CPT codes which are not inclusive in Anesthesia billing

CPT® codes describing services that are integral to an anesthesia service include but are not limited to, the following:

•  99201-99499 (Evaluation and management)

The CPT® book, in its Anesthesia Guidelines, at the start of the Anesthesia section, states, “These services include the usual preoperative and postoperative visits….”

In a copy of a lecture presented by Dr. James Arens, posted on the ASA website, he discusses the fact that these pre-operative visits are not payable.

“For many years the preoperative visit was considered to be part of the global fee for anesthesia services based upon base units plus time. With the advent of preoperative anesthesia(assessment) clinics, the scope of this service has undergone drastic change. The history and past records review has become much more extensive. The evaluation of the patient and the explanation of the risk and options have also become much more detailed. I have heard surgeons state that they are no longer "capable" of assessing patients to undergo anesthesia. Yet the ability to bill for such services is very limited. The values of a well run preoperative clinic are self-evident. However, the inability to collect for these services rendered has caused several clinics to be closed. The codes (99201-99205) for evaluation and management services are quite simple. However, reimbursement for this valuable service remains problematic.”

Summary:

It would be improper for any group to bill for preoperative anesthesia assessments.  The payment for that service is included in the payment for the anesthesia payment itself.  Any money collected for these services in the would have to be returned to the payers.  In addition, any hospital providing this service would need to review with its attorney the issue of providing financial support to a for-profit entity.

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