Billing and Documentation

All,

I was hoping to get any guidance regarding giving anesthesia in the ICU as a critical care anesthesiologist. For example, when providing anesthesia for a bedside tracheostomy or ex-lap on one of your ICU patients you are rounding on, does one bill additional critical care time (with all the appropriate documentation) or open an anesthesia record and bill anesthesia time. Obviously you can't bill both but this time should be reimbursed in some manner. I cannot find anything regarding this in CMS manuals and colleagues around the country seem to do it both ways with no clear favorite. I know there is a theoretical concern that billing anesthesia time means you can't also being caring for your other ICU patients but I haven't seen anything written down saying you can't do this. In addition, having anesthesia fellows/residents in the room may mitigate that concern.

Appreciate any thoughts/suggestions. Thank you.

------------------------------
Nitin Mehdiratta
Duke University Medical Center
Durham NC
------------------------------

Original Message:
Sent: 12/29/2022 10:50:00 AM
From: Nitin Mehdiratta
Subject: Critical care anesthesiologist providing anesthesia within in the ICU

All,

I was hoping to get any guidance regarding giving anesthesia in the ICU as a critical care anesthesiologist. For example, when providing anesthesia for a bedside tracheostomy or ex-lap on one of your ICU patients you are rounding on, does one bill additional critical care time (with all the appropriate documentation) or open an anesthesia record and bill anesthesia time. Obviously you can't bill both but this time should be reimbursed in some manner. I cannot find anything regarding this in CMS manuals and colleagues around the country seem to do it both ways with no clear favorite. I know there is a theoretical concern that billing anesthesia time means you can't also being caring for your other ICU patients but I haven't seen anything written down saying you can't do this. In addition, having anesthesia fellows/residents in the room may mitigate that concern.

Appreciate any thoughts/suggestions. Thank you.

------------------------------
Nitin Mehdiratta
Duke University Medical Center
Durham NC
------------------------------

One can provide anesthesia care and bill for it separate from critical care while in the ICU as long as the time spent is distinctly separate and documentation follows guidelines for each.
A few groups prefer another anesthesiologist-intensivist,if available, to provide anesthesia care to the patient to make it even more distinct, rather than the same anesthesiologist-intensivist providing both on the same day.Not required.

------------------------------
Piyush Mathur
The Cleveland Clinic
Cleveland OH
------------------------------

Original Message:
Sent: 12-29-2022 09:49
From: Nitin Mehdiratta
Subject: Critical care anesthesiologist providing anesthesia within in the ICU

All,

I was hoping to get any guidance regarding giving anesthesia in the ICU as a critical care anesthesiologist. For example, when providing anesthesia for a bedside tracheostomy or ex-lap on one of your ICU patients you are rounding on, does one bill additional critical care time (with all the appropriate documentation) or open an anesthesia record and bill anesthesia time. Obviously you can't bill both but this time should be reimbursed in some manner. I cannot find anything regarding this in CMS manuals and colleagues around the country seem to do it both ways with no clear favorite. I know there is a theoretical concern that billing anesthesia time means you can't also being caring for your other ICU patients but I haven't seen anything written down saying you can't do this. In addition, having anesthesia fellows/residents in the room may mitigate that concern.

Appreciate any thoughts/suggestions. Thank you.

------------------------------
Nitin Mehdiratta
Duke University Medical Center
Durham NC
------------------------------

I believe the comments to date are spot on. Appropriate documentation should allow for anesthesia billing in this setting. A variant of this is how to code for CPR, ACLS and critical care time.
Something to consider is that some payors have a 'cap' on critical care time spent at the bedside, not recognizing time spent above their defined maximum in a 24 hour period. Such a stand would favor the anesthesia billing component.

------------------------------
Daniel Brown
Chair, Division of Critical Care Medicine
Mayo Foundation
Rochester MN
------------------------------

Original Message:
Sent: 12-29-2022 10:53
From: Piyush Mathur
Subject: Critical care anesthesiologist providing anesthesia within in the ICU

One can provide anesthesia care and bill for it separate from critical care while in the ICU as long as the time spent is distinctly separate and documentation follows guidelines for each.
A few groups prefer another anesthesiologist-intensivist,if available, to provide anesthesia care to the patient to make it even more distinct, rather than the same anesthesiologist-intensivist providing both on the same day.Not required.

------------------------------
Piyush Mathur
The Cleveland Clinic
Cleveland OH

Original Message:
Sent: 12-29-2022 09:49
From: Nitin Mehdiratta
Subject: Critical care anesthesiologist providing anesthesia within in the ICU

All,

I was hoping to get any guidance regarding giving anesthesia in the ICU as a critical care anesthesiologist. For example, when providing anesthesia for a bedside tracheostomy or ex-lap on one of your ICU patients you are rounding on, does one bill additional critical care time (with all the appropriate documentation) or open an anesthesia record and bill anesthesia time. Obviously you can't bill both but this time should be reimbursed in some manner. I cannot find anything regarding this in CMS manuals and colleagues around the country seem to do it both ways with no clear favorite. I know there is a theoretical concern that billing anesthesia time means you can't also being caring for your other ICU patients but I haven't seen anything written down saying you can't do this. In addition, having anesthesia fellows/residents in the room may mitigate that concern.

Appreciate any thoughts/suggestions. Thank you.

------------------------------
Nitin Mehdiratta
Duke University Medical Center
Durham NC
------------------------------