Anesthesiologist E/M

Good afternoon-

Quick question-thoughts on anesthesiologists billing for a preoperative E/M based on their belief they perform the most comprehensive.

Thanks in advance,

Donna

Donna M. Beaulieu, C-CDI, CPMA, CPC-I, CRC, CPC, CEMC, CIMC, CEDC, CFPC, CCP-P, CRP
Certified Green Belt, Lean Six Sigma
Assistant Director, Patient Financial Services
Emory Healthcare

Comments

  • Donna:

    Anesthesiologists can and do bill for E&M's but it has to fall outside the normal pre anesthetic evaluation. For them to bill an E&M for every pt they provide anesthesia for will probably result in serious trouble for them. They should really seek legal advice from a large healthcare legal firm that specializes in anesthesia.

    Gerry Malloy
    Global Health Management Services, LLC
    Tamaqua, PA 18252
    Www.globalhealthmgt.com

  • Good morning, and thank you for your response. Agree it should not be an “every patient event”. I read an article the society has out there, and the pre-op format they show is indeed way above what I expected.

    Thanks again,

    Donna



  • Your welcome. Probably saved your Docs some big problems. :)


    Gerry

  • edited May 2017
    I have a question:



    Do the anesthesia codes have inherent E/M’s – like surgery does?



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



  • Yes, they do. There are no differences when it comes to E/M coding.
    Leslie Johnson

    L J's phone

    -
  • The thing is, anesthesia codes include the physical portion of the exam so you don't feel an anesthesia code and an e/m unless the procedure was performed by a non MD.


    L J's phone

  • Agreed. I think they are looking more toward a comprehensive E/M (the Society’s recommended exam is pretty hefty), and then if for some reason the surgery is cancelled, they will bill the E/M. In my experience, it is typically the PCP/IM who performs the actual pre-op “clearance”.

    Thanks,

    Donna

  • edited May 2017
    Makes sense if the inherent E/M is there, much like with the surgeon.



    The surgeon is paid for the pre-op work. Years ago, I had a group of surgeons that needed to hear that……the hospital required a pre-op H&P (risk or what-not) for their records, the surgeons would automatically send the patient to the PCP – every time. I showed them the components of the pre/intra/post-op parts of surgery coding and reimbursement. Although they were none too happy, they agreed if the patient had no precluding issue/problem/disease process they could evaluate themselves, they would evaluate the patient and complete the pre-op form for the hospital’s records.



    It’s certainly a case-by-case basis. Considering there are patients who have no history of disease and no presenting problems, other than for the necessary surgery, there can always be that one patient who runs into difficulty at the last moment – or the anesthesiologist feels the need to evaluate. We want them to practice medicine when they need to – and be paid for it.





    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



  • The way someone from the ASA explained to me is that the anesthesia provider should fully document the pre-op eval. That way IF the service is cancelled at the right time AND the anesthesia provider's documentation shows his work reached the level of an E/M visit, he'll be able to report the exam.
  • Thank you. Well said.

    Donna

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