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Billing for Preoperative Anesthesia Consultations for Cancelled Surgeries
Richard H. Epstein, M.D., CPHIMS, George Pereira-Ogan, M.B.A.
Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania, United States.
Introduction. The preoperative anesthesia consultation is ordinarily a bundled component of the professional surgical anesthesia charge. However, if a preop consult is completed, but the procedure is canceled, the encounter can be billed as an office visit under an Evaluation and Management (E&M) CPT code if the documentation requirements are satisfied. Also, if the procedure is rescheduled after the expiration date of the consultation, and the consult is redone, the preop visit can be billed.

Methods. Most patients who undergo surgery at our institution are seen by an anesthesiologist in the Preoperative Testing Clinic (PTC) using an electronic medical record system developed in house (JeffSprint). PTC appointments and surgical procedures are scheduled using an OR information system (ORSOS, Per-Sé Technologies). Professional anesthesia charges are entered into the anesthesia module of IDX BAR (IDX). Patients evaluated in JeffSprint are matched to records in the post case tables in ORSOS to find patients who did not have a surgical procedure within 60 days of their PTC visit. These records are compared to corresponding IDX billing records to ensure that no anesthesia charges were submitted for dates of service within that 60-day window. The preoperative consultation is then printed and sent to the anesthesia billing office, where the appropriate E&M code is applied by a certified coder and an IDX invoice generated. We evaluated the aggregated billing records, without patient identifiers, for the relevant E&M CPT codes (99202-99205) to determine the financial performance of this process for FY03 and FY04 to date. The codes represent evaluations of patients with increasing medical complexity and correspondingly higher levels of medical decision-making (see ).

Results. Approximately 4% of patients seen in the PTC have their surgery canceled in the 60 days following the preop evaluation (Table). During FY 2003, the average reimbursement across all carriers was 21.5% of charges. Yearly revenue from canceled PTC patients is approximately $18,000.Discussion. Our methodology of identifying patients is conservative, in that we exclude patients undergoing any procedure within 60 days of the PTC visit. Applying a check against the IDX BAR database provides additional protection against sending out inappropriate invoices. We do not capture cancellations following preoperative evaluations completed manually (e.g., when the system is down). The process of identifying patients who have their surgery cancelled following a PTC visit is automated, and would likely be impractical without an OR/Anesthesia Information System in place. Although our reimbursement for patients canceling surgery is relatively small, it represents revenue that can be collected with a relatively minor effort. At facilities with higher cancelation rates, the income will be correspondingly higer. It is important that the records for such visits be retained and that the E&M service billed is supported by written documentation.

Anesthesiology 2004; 101: A1401
Table. Preoperative Consultation Billing for Cancelled Surgeries
# patients seen in Patient Testing Center97459984
Surgery canceled4.05%3.97%
# 92202 consults110108
# 92203 consults248235
# 92204 consults3653
# 92205 consults10
Total Charges$82,940$84,113
*annualized as of 2/28/04