Forum - Questions & Answers

Feb 6th, 2018 - kjenk

Anesthesiologist Billing for E/M visits

I am interested in hearing comments regarding anesthesiologist providing E/M visits to patients that have multiple co-morbidities that need evaluation and management prior to decision for surgery.
My providers want to see these patients in clinic 6-2 weeks prior to surgery therefore it would not be part of the Anesthesia package.
Comments please.

Feb 26th, 2018 - ChrisW   256  1 

re: Anesthesiologist Billing for E/M visits

The use of E&M Codes are more complex and require a different level of interaction. The documentation requirements include some critical elements related to the service that are not required with traditional anesthesia billing requirements, while Anesthesia is billed based on time, E&M is based on elements of the patient's history. Because the pre-op exam is included in 00100-01999, There would need to be documentation of medical necessity for a separate charge which may substantiate the need for the additional service, in addition, you must report an NCCI associated modifier which is added to the E&M code.

The American Society of Anesthesiologists states when billing for an E&M service, “The services must be separately identifiable and significant E&M services that are clearly beyond those necessary to evaluate the patient for anesthesia or necessary to safely provide anesthesia services. To qualify as a separate service, the anesthesiologist must provide services beyond the preoperative anesthesia exam. In most cases, this should include medical management of underlying diseases to optimize the patient for the surgical procedure and anesthesia. These could include a comprehensive evaluation of the patient's medical condition and management of those issues that need to be corrected or optimized prior to surgery and anesthesia, or managing the patient's medical conditions after the surgical procedure”.

The American Society of Anesthesiologists also warns, “Separate charges for E&M services by anesthesiologists could raise red flags with Medicare, Medicaid, the Office of the Inspector General (OIG) or Recovery Audit.”

Please refer to the two articles below by American Society of Anesthesiologists:

What Anesthesiologists Need to Know about Reporting E&M or TCM

Reporting E&M Services and Anesthesia Services Together in the Pre-operative Period

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