Billing and Documentation

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  • 1.  Critical care anesthesiologist providing anesthesia within in the ICU

    Posted 12-29-2022 09:50
    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.

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    Nitin Mehdiratta
    Duke University Medical Center
    Durham NC
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  • 2.  RE: Critical care anesthesiologist providing anesthesia within in the ICU

    Posted 12-29-2022 10:32
    By definition, anytime you provide critical care, you are suppose to be providing care to a single individual patient, (covering does not count). If you provide General anesthesia,  document with an anesthetic records like you do in the OR, you are allowed to bill under the anesthesia guidelines.  If you are only providing sedation then you should bundle it into your critical care time. The core question is are you providing anesthesia or just sedation. Get an anesthesia sheet from the OR and you should be good for anesthesia billing just like in the OR.  

    Bob

    Robert Schulze MD MBA CPC FACS FCCM 

    Sent from my iPad





  • 3.  RE: Critical care anesthesiologist providing anesthesia within in the ICU

    Posted 12-29-2022 10:54
    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.

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    Piyush Mathur
    The Cleveland Clinic
    Cleveland OH
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  • 4.  RE: Critical care anesthesiologist providing anesthesia within in the ICU

    Posted 12-29-2022 11:13
    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.

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