Rid Your Invasive Lines Documentation Challenges With These Tips

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Every detail matters when your anesthesia providers place invasive lines that are separately reportable from the standard anesthesia service.

Remember that line placement is a surgical procedure; as such, the service must be documented before a payer will reimburse.

Stay away from denials by training your anesthesia providers to document these five components of line insertion without fail.

Support medical necessity

As standard anesthesia care includes so many services, documenting medical necessity for additional lines is important. For instance, the patient might have coarctation (747.10, Coarctation of aorta [preductal] [postductal]), a narrowing of the aorta between the upper and lower body branches. That type of condition or more common issues such as circulatory problems might also need an additional arterial line for the anesthesiologist's monitoring purposes.

Watch the clock

Your providers should by now be familiar to documenting their start and stop times for any anesthesia case. If they place lines during a case they expect to bill separately, ...
... remind them to document each line's start and stop time by yourself.

Tip: If your provider places the line intraoperatively, you do not normally need to deduct the placement time from the anesthesia time. If your provider places the lines before the anesthesia time begins, be sure the case start time is after the line placement time to avoid ‘double dipping'.

Identify the location

The operative note should document where the provider placed the line, like the right radial artery" or right intrajugular." The note does not make a difference in your code selection; however is good documentation of the line placement.

Validate barrier method/technique

If your physicians submit data for PQRS, they should be on the look-out for ways their documentation can support reporting the anesthesia measures. Documenting sterile technique or maximal barrier sterile technique (MSBT) helps support reporting PQRS (Physician Quality Reporting System) measure 76 (Prevention of catheter-related bloodstream infections [CRBSI): Central venous catheter [CVC] insertion protocol).

Measure 76 tracks the percentage of patients who undergo CVC insertion when the provider uses all elements of maximal sterile barrier technique. Requirements say that providers use cap, mask, sterile gown, sterile gloves, a large sterile sheet, hand hygiene, and 2 percent chlorhexidine for cutaneous antisepsis.

Include the provider's name and signature

Even if you have every other detail noted, you will only be reimbursed when the chart includes the provider's name and signature.

Definition of a handwritten signature is a mark or sign by an individual on a document to signify knowledge, approval, acceptance or obligation.

Medicare guidelines allow a handwritten or electronic signature on orders or other medical record documentation for review. Stamped signatures aren't acceptable; however the provider can sign her initials over her printed or typed name.

For more specialty-specific articles to aid your anesthesia coding, sign up for a medical coding resource like the Coding Institute.