When to use anaesthesia unit fee code E013C

Education and Prevention Committee Billing Briefs

Education and Prevention Committee (EPC) Billing Briefs are prepared jointly by the Ministry of Health (MOH) and the Ontario Medical Association (OMA) to provide general advice and guidance to physicians on billing matters.

Category: Anaesthesiology; Family Physician – Anaesthesia; Emergency Medicine; Critical Care
Date Issued: August 9, 2023

Description and Clinical Scenarios that relate to E013C

• E013C is listed in the Schedule of Benefits – Physician Services (Schedule) under Anaesthesiologists’ Services on page GP99.
• E013C is eligible for payment when anaesthesia services are being provided for a surgical procedure with basic anesthesia units listed.
  • If claimed, the basic units listed in association with E013C replace the basic units of the procedure being performed.
• This fee code is eligible for payment when anaesthetic management is required at the time of a surgical procedure for the emergency relief of acute upper airway obstruction, above the carina, with the exception of choanal atresia.
• This fee code should only be claimed in the clinical setting of a life-threatening emergency related to structural upper airway obstruction requiring anaesthetic management at the time of surgery.
• Examples of clinical situations which result in structural acute upper airway obstruction include:
  • Infection (example, epiglottitis, abscess)
  • Obstructive tumour
  • Foreign body
  • Acute trauma (example, causing distortion or narrowing of airway)

Clinical Scenarios that do not relate to E013C

• E013C is not a “stand-alone” fee code. It is only eligible for payment when claimed in association with a surgical procedure associated with basic anesthesia units.
• Intubation of a patient as part of any of the following services, is not eligible for payment as E013C:
  • Life Threatening Critical Care (G521, G522, G523 or G391),
  • Other Critical Care (G395 or G391), or
  • Critical care per diems (listed starting on page J33).
• Endotracheal intubation for resuscitation that is unrelated to a surgical procedure (for example, acute smoke inhalation or decreasing level of consciousness) may be claimed as G211, only if other critical care fee codes or per diems are not eligible for payment.

Examples

Example 1:  Acute airway obstruction

Dr. Judd is an anaesthesiologist who is called to the Emergency Department to provide urgent airway management for a patient with an acute deep neck abscess and impending upper airway obstruction. Dr. Judd was able to safely intubate the patient and relieve impending acute upper airway obstruction. They then provided general anesthesia services for the surgical procedure (claimed by the surgeon as Z524A - Drainage of haematoma or deep neck abscess, external approach).

What is eligible for payment to Dr. Judd?

Explanation:

• In this circumstance, endotracheal intubation is considered a component of the subsequent anaesthetic procedure.
• The anesthetic portion of this procedure is normally eligible for payment as Z524C; in this case, 7 basic units plus time units reflecting the start/stop times for anesthesia would be eligible for payment. However, due to the patient’s upper airway obstruction, E013C with 10 basic units plus time units reflecting the start/stop times for anesthesia is eligible for payment.

Example 2: Intubation with “difficult airway”, without acute airway obstruction

Three days later, Dr. Judd is providing elective anesthesia services for patients undergoing colonoscopy procedures. Is E013C eligible for payment for services rendered to patients with difficult airways instead of E032C which is the usual fee code used for such cases?

Explanation:

• No. E013C is only eligible for payment where the patient has structural acute upper airway obstruction above the carina (see above for possible clinical scenarios).
• E013C is not eligible for payment for services rendered to patients with non-acute “difficult airways”.
• E032C is eligible for payment.

Example 3: Intubation by physician providing life threatening critical care

Dr. Currin is an Emergency Department physician on duty when a patient is brought in by ambulance following a fall from a significant height. The patient has multiple injuries including a cervical spine fracture and requires resuscitation, including intubation for airway control.

What is eligible for payment to Dr. Currin for these services?

Explanation:

• Life Threatening Critical Care fee codes (G521A/G523A/G522A) are eligible for payment for the time providing resuscitation services.
• These fee codes include endotracheal intubation and so no other fee is applicable for this service, whether or not the patient was deemed to have acute airway obstruction.
• This is also applicable for physicians claiming other critical care fee codes (G391A, G395A, G391A) or per diems who perform intubation.
• E013C is not eligible for payment when it is appropriate to claim Critical Care fee codes.

Example 4: Intubations for airway management without a subsequent surgical procedure

Dr. Currin provides an assessment and critical care services for a patient who is brought to the Emergency Department following a house fire. Dr. Judd provides an assessment and subsequently intubates the patient at Dr. Currin’s request because of concern regarding super-heated air inhalation. Dr. Judd does not provide any other critical care services.

What is eligible for payment to Dr. Judd in addition to the appropriate assessment (or consultation) fee code?

Explanation:

• As the patient does not undergo a subsequent surgical procedure G211A (endotracheal intubation for resuscitation) is eligible for payment.
• E013A is not eligible for payment in this clinical scenario.

Example 5: Emergency tracheostomy with sedation

A patient with a recently diagnosed laryngeal malignancy presents to the Emergency Department with acute airway obstruction. Dr. Simon, an Otolaryngologist, assesses the patient and determines that an emergency tracheostomy (Z325A) is required. The patient is transferred urgently to the Operating Room. Under sedation and local anesthetic, the surgeon performs a tracheostomy. Dr. Dafoe, an anaesthesiologist, provides sedation and monitors the patient who is not intubated.

What is eligible for payment to Dr. Dafoe?

Explanation:

• The Schedule defines general anaesthesia as “all forms of anaesthesia except local infiltration”. This includes procedural sedation.
• Z325C (10 basic + time unit) is eligible for payment given that the patient underwent procedural sedation and monitoring during the procedure.
• E013A is not eligible for payment in this clinical scenario.

Keywords/Tags

Claims Contact Information

If you have any billing or claims submission inquiries, please contact the Service Support Contact Centre (SSCC) by email or by calling 1-800-262-6524.

To provide feedback on EPC Billing Briefs, or to suggest topics for future EPC Billing Briefs, send an email to the attention of the joint Ministry of Health/OMA Education and Prevention Committee.

The Ministry of Health (MOH) and the Ontario Medical Association (OMA) have jointly prepared this educational resource to provide general advice and guidance to physicians on specific billing matters.

Image

Note: This document is technical in nature and is available in English only due to its limited targeted audience. This publication has been exempted from translation under the French Language Services Act. For questions or support regarding this document, please contact the Service Support Contact Centre (SSCC) by email or by calling 1-800-262-6524.

Remarque : Ce document est de nature technique et est disponible en anglais uniquement en raison de son public cible limité. Ce document a été exempté de la traduction en vertu de la Loi sur les services en français. Pour toute question ou de l’aide concernant ce document, veuillez contacter Les Services de renseignements, Centre de contact pour le soutien des services par courriel ou en téléphonant le 1-800-262-6524.