Sunday, June 26, 2016

Anesthesia Time and Calculation of Anesthesia Time Units



Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the  patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is, when the patient may be placed safely under postoperative care. Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time for services furnished on or after January 1, 2000, the anesthesia practitioner can add blocks of time around an interruption in anesthesia time as long as the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption.


Actual anesthesia time in minutes is reported on the claim. For anesthesia services furnished on or after January 1, 1994, the A/B MAC computes time units by dividing reported anesthesia time by 15 minutes. Round the time unit to one decimal place. The A/B MAC does not recognize time units for CPT codes 01995 or 01996.

For purposes of this section, anesthesia practitioner means a physician who performs the anesthesia service alone, a CRNA who is not medically directed, or a CRNA or AA, who is medically directed. The physician who medically directs the CRNA or AA would ordinarily report the same time as the CRNA or AA reports for the CRNA service.


H
. Base Unit Reduction for Concurrent Medically Directed Procedures 

If the physician medically directs concurrent medically directed procedures prior to January 1, 1994, reduce the number of base units for each concurrent procedure as follows.

• For two concurrent procedures, the base unit on each procedure is reduced 10 percent.

• For three concurrent procedures, the base unit on each procedure is reduced 25 percent.

• For four concurrent procedures, the base on each concurrent procedure is reduced 40 percent.

• If the physician medically directs concurrent procedures prior to January 1, 1994, and any of the concurrent procedures are cataract or iridectomy anesthesia, reduce the base units for each cataract or iridectomy procedure by 10 percent.

Thursday, June 23, 2016

Billing and Payment for Multiple Anesthesia Procedures



Physicians bill for the anesthesia services associated with multiple bilateral surgeries by reporting the anesthesia procedure with the highest base unit value with the multiple
procedure modifier “-51.” They report the total time for all procedures in the line item with the highest base unit value.

If the same anesthesia CPT code applies to two or more of the surgical procedures, billers enter the anesthesia code with the “-51” modifier and the number of surgeries to which the modified CPT code applies.

Payment can be made under the fee schedule for anesthesia services associated with multiple surgical procedures or multiple bilateral procedures. Payment is determined based on the base unit of the anesthesia procedure with the highest base unit value and time units based on the actual anesthesia time of the multiple procedures.


Payment at Medically Supervised Rate

The Part B Contractor may allow only three base units per procedure when the anesthesiologist is involved in furnishing more than four procedures concurrently or is performing other services while directing the concurrent procedures. An additional time unit may be recognized if the physician can document he or she was present at induction.

Payment for Medical and Surgical Services Furnished in Addition to Anesthesia Procedure

Payment may be made under the fee schedule for specific medical and surgical services furnished by the anesthesiologist as long as these services are reasonable and medically necessary or provided that other rebundling provisions (see §30 and Chapter 23) do not preclude separate payment. These services may be furnished in conjunction with the anesthesia procedure to the patient or may be furnished as single services, e.g., during the day of or the day before the anesthesia service. These services include the insertion of a Swan Ganz catheter, the insertion of central venous pressure lines, emergency intubation, and critical care visits.

Sunday, June 19, 2016

Payment at the Medically Directed Rate


The Part B Contractor determines payment for the physician’s medical direction service furnished on or after January 1, 1998, on the basis of 50 percent of the allowance for the service performed by the physician alone. Medical direction occurs if the physician medically directs qualified individuals in two, three, or four concurrent cases and the physician performs the following activities.

• Performs a pre-anesthetic examination and evaluation;

• Prescribes the anesthesia plan;

• Personally participates in the most demanding procedures in the anesthesia plan, including induction and emergence;

• Ensures that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist;

• Monitors the course of anesthesia administration at frequent intervals;

• Remains physically present and available for immediate diagnosis and treatment of emergencies; and

• Provides indicated-post-anesthesia care.


Prior to January 1, 1999, the physician was required to participate in the most demanding procedures of the anesthesia plan, including induction and emergence.
For medical direction services furnished on or after January 1, 1999, the physician must participate only in the most demanding procedures of the anesthesia plan, including, if applicable, induction and emergence. Also for medical direction services furnished on or after January 1, 1999, the physician must document in the medical record that he or she performed the pre-anesthetic examination and evaluation. Physicians must also document that they provided indicated post-anesthesia care, were present during some portion of the anesthesia monitoring, and were present during the most demanding procedures, including induction and emergence, where indicated.
For services furnished on or after January 1, 1994, the physician can medically direct two, three, or four concurrent procedures involving qualified individuals, all of whom could be CRNAs, AAs, interns, residents or combinations of these individuals. The medical direction rules apply to cases involving student nurse anesthetists if the physician directs two concurrent cases, each of which involves a student nurse anesthetist, or the physician directs one case involving a student nurse anesthetist and another involving a CRNA, AA, intern or resident.

For services furnished on or after January 1, 2010, the medical direction rules do not apply to a single resident case that is concurrent to another anesthesia case paid under the medical direction rules or to two concurrent anesthesia cases involving residents.

If anesthesiologists are in a group practice, one physician member may provide the pre-anesthesia examination and evaluation while another fulfills the other criteria. Similarly, one physician member of the group may provide post-anesthesia care while another member of the group furnishes the other component parts of the anesthesia service. However, the medical record must indicate that the services were furnished by physicians and identify the physicians who furnished them.

A physician who is concurrently directing the administration of anesthesia to not more than four surgical patients cannot ordinarily be involved in furnishing additional services to other patients. However, addressing an emergency of short duration in the immediate area, administering an epidural or caudal anesthetic to ease labor pain, or periodic, rather than continuous, monitoring of an obstetrical patient does not substantially diminish the scope of control exercised by the physician in directing the administration of anesthesia to surgical patients. It does not constitute a separate service for the purpose of determining whether the medical direction criteria are met. Further, while directing concurrent anesthesia procedures, a physician may receive patients entering the operating suite for the next surgery, check or discharge patients in the recovery room, or handle scheduling matters without affecting fee schedule payment.

However, if the physician leaves the immediate area of the operating suite for other than short durations or devotes extensive time to an emergency case or is otherwise not available to respond to the immediate needs of the surgical patients, the physician’s services to the surgical patients are supervisory in nature. Carriers may not make payment under the fee schedule.

Thursday, June 16, 2016

BCBS claim filing limit for Anesthesia claims

Claim Filing
Effective for dates of service on or after January 1, 2014, Blue Cross requires claims for anesthesiologists, CRNAs and AAs to be billed under the name and National Provider Identifier (NPI) of the provider who  actually rendered the service. Blue Cross does not recognize “incident to” billing for anesthesia services. All providers should render services based on the scope of their particular license and requirements of the State of Alabama. Practitioners (anesthesiologists, CRNAs and AAs) must each file for the professional anesthesia services they performed electronically on the electronic 837 Professional 5010. For CRNA services performed on or after January 1, 2014, services will no longer be reimbursed through the hospital Blue Cross Cost Study. Both CRNA costs and charges should be excluded from the costs and charges reported in the hospital Blue Cross Cost Study.


Coding

Qualified anesthesia providers may bill directly for services using CPT anesthesiology codes 00100 – 01999. While some surgical CPT codes are appropriate to use when billing anesthesia services (e.g., CPT code 36620) the majority of anesthesia services should be billed using codes in the range of 00100 – 01999.


Base Units
The base unit is the value assigned to each CPT code and includes all usual services except the time actually spent in anesthesia care. Pre-operative and post-operative visits are usually included. When multiple anesthesia services are performed, only the anesthesia services with the highest base unit value should be filed with total time for all services reported on the highest base unit value. The base units value should never be entered in the “units” field when filing claims. Effective for dates of service on or after January 1, 2014, Blue Cross will utilize the Centers for Medicare & Medicaid Services (CMS) base unit values.

Monday, June 13, 2016

Payment at Personally Performed Rate


The Part B Contractor must determine the fee schedule payment, recognizing the base unit for the anesthesia code and one time unit per 15 minutes of anesthesia time if:
• The physician personally performed the entire anesthesia service alone;

• The physician is involved with one anesthesia case with a resident, the physician is a teaching physician as defined in §100, and the service is furnished on or after January 1, 1996;

• The physician is involved in the training of physician residents in a single anesthesia case, two concurrent anesthesia cases involving residents or a single anesthesia case involving a resident that is concurrent to another case paid under the medical direction rules. The physician meets the teaching physician criteria in §100.1.4 and the service is furnished on or after January 1, 2010;

• The physician is continuously involved in a single case involving a student nurse anesthetist;

• The physician is continuously involved in one anesthesia case involving a CRNA (or AA) and the service was furnished prior to January 1, 1998. If the physician is involved with a single case with a CRNA (or AA) and the service was furnished on or after January 1, 1998, carriers may pay the physician service and the CRNA (or AA) service in accordance with the medical direction payment policy; or

• The physician and the CRNA (or AA) are involved in one anesthesia case and the services of each are found to be medically necessary. Documentation must be submitted by both the CRNA and the physician to support payment of the full fee for each of the two providers. The physician reports the “AA” modifier and the CRNA reports the “QZ” modifier for a nonmedically directed case.

Friday, June 10, 2016

Regional Anesthesia CPT code 01967, 01968 and 01969


Topical anesthesia, local, local infiltration and/or metacarpal/digital block, is included in the basic allowance of the surgical procedure performed. No additional reimbursement is provided.

• Nerve Blocks -A nerve block involves the injection of a peripheral nerve into or around a given site. If the anesthesiologist administers the injection or block postoperatively in an area separate from the operating room as part of the anesthesia time, additional time required for the injection may be included in the total number of anesthesia minutes reported. If a qualified anesthesia provider remains with the patient, the time should be reported as continuous rather than discontinuous.

• Spinal, Subarachnoid or Subdural Anesthesia - Spinal, subarachnoid and subdural anesthesia involves the injection of anesthetic or narcotic drugs into the spinal cord. When performed as the primary type of anesthesia, the time required is included in the total anesthesia minutes reported.

• Epidurals -Epidural analgesia involves the administration of a narcotic drug through an epidural catheter. When performed as the primary type of anesthesia, the time required is included in the total anesthesia minutes reported.

• Labor Epidurals -Anesthesia for labor epidurals are time based services and should be billed as total minutes.

o 01967: Vaginal delivery with epidural for pain management. Code may be reported as a single anesthesia service. Depending on the terms of the participating provider agreement, reimbursement may be based on base units plus time units (insertion through delivery) subject to a cap of 7 hours or 420 minutes.

o 01968: Cesarean delivery following failed attempt at vaginal delivery. This is an add-on code and should always be reported with
01967.

o 01969: Cesarean delivery followed by a cesarean hysterectomy after failed planned vaginal delivery. This is an add-on code and should always be reported with 01967.

Note: Florida Blue has incorporated the NCCI Edits into our system. Transesophageal Echocardiography (TEE) Placement and Interpretation is no longer considered for separate reimbursement in addition to payment for the primary anesthesia procedure.

Wednesday, June 8, 2016

Anesthesia During Delivery CPT codes 01967, 99140,


Labor Epidurals

Anesthesia for labor epidurals are time-based services and should be billed as total minutes.

CPT code 01967: Neuraxial Labor Analgesia/Anesthesia for Planned Vaginal Delivery

This includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor.)  Code may be reported as a single anesthesia service.

CPT code 01968: Cesarean delivery following failed attempt at vaginal delivery This is an add-on code and should always be reported with CPT code 01967.

CPT code 01969: Cesarean delivery followed by a cesarean hysterectomy after  failed planned vaginal delivery

This is an add-on code and should always be reported with CPT code 01967.

CPT code 99140: This add-on code may be billed for labor ending in an urgent or emergency cesarean delivery with four additional units.

Note: 01967 and add-on codes 01968 and 01969 require a concurrency modifier in the first position.

Scenarios:

• For labor less than 4 hours ending in vaginal delivery : CPT code 01967

• For labor less than 4 hours ending in a cesarean delivery: CPT code 01967 and 01968

• For labor ending in an urgent or emergency cesarean delivery, CPT code 99140 may be billed with CPT code 01967 and 01968

• For labor 4 hours or more ending in a vaginal delivery: CPT code 01967 with modifier 23

• For labor 4 hours or more ending in a cesarean delivery : CPT code 01967 with modifier 23 and add on CPT code 01968

• For labor ending in an urgent or emergency cesarean delivery: CPT code 01967 with add-on code 01968 and 99140

Note: Payment for anesthesia administered by the delivering physician is included in the global maternity fee.