Wednesday, September 28, 2016

Billing Guide - Two anesthesiologist performed

One Procedure – Two Anesthesiologists or Two CRNAS

If one practitioner begins the anesthesia and has to leave the patient to start another procedure and a second practitioner finishes the procedure the one who is with the patient that spent the longest time with the patient can bill. That practitioner should report the combined total of minutes. Documentation must support the time spent by both practitioners.

Pain Management

Covered pain management services provided by anesthesia practitioners should be billed using the most appropriate CPT code. Modifiers AA, AD, QK, QX, QY or QZ should not be used. Neither should physical status modifiers P1 through P6 be used.

Types of Pain management includes the following:

• Post Operative pain management placement of epidural

• Post-operative pain management – daily hospital management of epidural (continuous) or subarachnoid (continuous) drug administration

• Should only be billed on post-operative days and not on the same day as the operative procedure

• Number of units should be billed not anesthesia time


Conscious Sedation

Conscious sedation is an altered level of consciousness that allows a patient to still respond to physical stimulation and verbal commands, and to maintain an unassisted airway. Conscious sedation is typically considered a part of the surgical procedure global package and not reimbursed separately.

In some cases however, a patient’s condition may warrant the use of conscious sedation with procedures where sedation is not normally used. This may include children, acutely agitated patients, or acutely ill patients who cannot have the procedure without sedation. The procedures included in this category that may require IV monitoring by an anesthesiologist include  ndoscopies, arteriograms, CT scans, MRIs, cardiac catheterizations, and PTCA


Sunday, September 25, 2016

CPT 64635, 64636, 64633 - definition covered ICD


CPT NEW DESCRIPTION 

64635  New code  Destruction by neurolytic agent paravertebral facet joint nerve(s) (fluoroscopy or CT; Lumbar or sacral, single facet joint

(For bilateral procedure, report 64635 with modifier 50)


64636 New code   Lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)



Paravertebral Facet Joint Denervation

1. If a provider denervates only one level, unilateral or bilateral, CPT codes 64633 or 64635 should be used. If the denervation is performed at more than one level, unilateral or bilateral, CPT codes 64634 and 64636 should be used for each of the subsequent levels. If denervation is performed bilaterally, Modifier 50 should be appended to the procedure code with number of services of one.

2. Use the appropriate CPT code in Item 24D on the CMS-1500 form (or electronic equivalent) and link it to the applicable ICD-9-CM code in Item 24E (or electronic equivalent).

3. Fluoroscopic and CT guidance and localization for needle placement, is included in codes 64633- 64636.

Revision History Number/Explanation


01/01/2012 CPT 2012 code update deleted codes 64622, 64623, 64626 and 64627, added new codes 64633, 64634, 64635, and 64636 removed codes 77003, 77012 and references to them. 08/01/2011 correction to Paravertebral Facet Joint Denervation number 3. Fluoroscopic guidance and localization for needle placement, is not included in codes 64622-64627 effective 03/18/2010.

Coverage Indications, Limitations, and/or Medical Necessity

    A paravertebral facet joint represents the articulation of the posterior elements of one vertebra with its neighboring vertebra. For the purposes of this Local Coverage Determination (LCD), the facet joint is noted at a specific level, by the vertebrae that form it (e.g., C4-5 or L2-3). There are two (2) facet joints at each level, left and right.

    Facet joint pain is generally suspected in patients with cervical, thoracic and or lumbar pain that may or may not have a radicular component, when focal tenderness is present over the facet joint, and increased symptoms due to rotation or extension of the spine.

    Destruction of a paravertebral facet joint nerve(s) requires the use of fluoroscopic guidance to confirm the proper positioning of the needle or electrode at the level of the involved paravertebral facet joint(s). Destruction of the paravertebral facet joint nerve (s) (median branch) can then be achieved by means of thermal, electrical or radiofrequency (rhizotomy) applications. Facet joint nerve destruction is considered a definitive form of treatment for facet joint pain. Therefore, it would not be expected to see multiple repeat facet joint destruction procedures performed once all of the involved facet joints at that spinal level on either side have been denervated. However, the nerves do have the ability to regenerate. If pain recurs in the same distribution and nature, the procedure may be provided at a maximum of two (2) sessions per year (per 12 months).

    Indications

    The destruction of cervical, thoracic or lumbar paravertebral facet joint (median branch) nerves will be considered to be medically reasonable and necessary as follows:

    • The paravertebral facet joint(s) have been identified as the source of the patient’s pain by undergoing a diagnostic paravertebral facet joint (median branch) block. Temporary or prolonged abolition of the pain suggests that the facet joint (s) are the source of the symptoms and appropriate for treatment; and

    • The patient failed conservative treatment. Conservative treatment may include local heat, traction, nonsteroidal anti-inflammatory medications and anesthetic and

    • The paravertebral facet joint(s) destruction is performed by appropriately trained providers.

    The CMS Manual System, Pub. 100-08, Program Integrity Manual, Chapter 13, Section 5.1 (http://www.cms.hhs.gov/manuals/downloads/pim83c13.pdf outlines that “reasonable and necessary" services are "ordered and/or furnished by qualified personnel."

    A qualified physician for this service/procedure is defined as follows: A) Physician is properly enrolled in Medicare. B) Training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program in the applicable specialty/subspecialty in the United States or must reflect equivalent education, training, and expertise endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States.

    Limitations

    The destruction of cervical, thoracic or lumbar paravertebral facet joint (median branch) nerves will not be considered medically reasonable and necessary when:

    • Performed without fluoroscopic guidance. A mandatory requirement of paravertebral facet joint (median branch) destruction is the use of fluoroscopic guidance to confirm the proper positioning of the needle electrode. Failure to use fluoroscopic guidance will result in the services receiving a denial; or

    • The medical records do not support that the patient experienced temporary or prolonged abolition of the pain after a facet joint nerve block injection; or

    • The medical records do not demonstrate that destruction was performed at the median branch of the spinal nerve innervating the facet joint.


Group 1 Codes
64633Destroy cerv/thor facet jnt
64634Destroy c/th facet jnt addl
64635Destroy lumb/sac facet jnt
64636Destroy l/s facet jnt addl



A patient undergoes a radiofrequency nerve destruction of two medial branch nerves L3 and L4 innervating the symptomatic lumbar facet joint. Reimbursement consideration is based upon the following code selection:

* 64635 — $516.47 (approximate 2012 ASC reimbursement) Coding tips:

* Image guidance and localization are required for the performance of paravertebral facet joint nerve destruction by neurolytic agent described by 64633-64636.

* Do not report 64633-64636 in conjunction with 77003 or 77012). Both CPT 77003 and/or 77012 are considered inclusive to the injection procedure in 2012. Note: If CT or fluoroscopic imaging is not used/documented, report unlisted CPT code 64999.

* If both facet joints at the same vertebral level are treated, then CPT 64633 or 64635 should be reported with modifier -50 appended pending carrier reporting requirements for bilateral procedures (-50 versus RT/LT versus units). 

ICD-10 Codes that Support Medical Necessity


M47.011Anterior spinal artery compression syndromes, occipito-atlanto-axial region
M47.012Anterior spinal artery compression syndromes, cervical region
M47.013Anterior spinal artery compression syndromes, cervicothoracic region
M47.014Anterior spinal artery compression syndromes, thoracic region
M47.015Anterior spinal artery compression syndromes, thoracolumbar region
M47.016Anterior spinal artery compression syndromes, lumbar region
M47.019Anterior spinal artery compression syndromes, site unspecified
M47.021Vertebral artery compression syndromes, occipito-atlanto-axial region
M47.022Vertebral artery compression syndromes, cervical region
M47.029Vertebral artery compression syndromes, site unspecified
M47.11Other spondylosis with myelopathy, occipito-atlanto-axial region
M47.12Other spondylosis with myelopathy, cervical region
M47.13Other spondylosis with myelopathy, cervicothoracic region
M47.14Other spondylosis with myelopathy, thoracic region
M47.16Other spondylosis with myelopathy, lumbar region
M47.21Other spondylosis with radiculopathy, occipito-atlanto-axial region
M47.22Other spondylosis with radiculopathy, cervical region
M47.23Other spondylosis with radiculopathy, cervicothoracic region
M47.24Other spondylosis with radiculopathy, thoracic region
M47.25Other spondylosis with radiculopathy, thoracolumbar region
M47.26Other spondylosis with radiculopathy, lumbar region
M47.27Other spondylosis with radiculopathy, lumbosacral region
M47.28Other spondylosis with radiculopathy, sacral and sacrococcygeal region
M47.811Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region
M47.812Spondylosis without myelopathy or radiculopathy, cervical region
M47.813Spondylosis without myelopathy or radiculopathy, cervicothoracic region
M47.814Spondylosis without myelopathy or radiculopathy, thoracic region
M47.815Spondylosis without myelopathy or radiculopathy, thoracolumbar region
M47.816Spondylosis without myelopathy or radiculopathy, lumbar region
M47.817Spondylosis without myelopathy or radiculopathy, lumbosacral region
M47.818Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region
M47.891Other spondylosis, occipito-atlanto-axial region
M47.892Other spondylosis, cervical region
M47.893Other spondylosis, cervicothoracic region
M47.894Other spondylosis, thoracic region
M47.895Other spondylosis, thoracolumbar region
M47.896Other spondylosis, lumbar region
M47.897Other spondylosis, lumbosacral region
M47.898Other spondylosis, sacral and sacrococcygeal region
M54.2Cervicalgia
M54.30Sciatica, unspecified side
M54.31Sciatica, right side
M54.32Sciatica, left side
M54.5Low back pain
M54.6Pain in thoracic spine
M96.1Postlaminectomy syndrome, not elsewhere classified

Thursday, September 22, 2016

CPT CODE 64483, 64479, 64484 - Anesthetic agent

CPT code and description


64479 - Injection, anesthetic agent and/or steroid, transforaminal epidural; Cervical or Thoracic, single level

64480 - Cervical or Thoracic, each additional level

64483 - Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level - average fee amount - $220 - $230

64484 – Lumbar or Sacral, each additional level


Whether a transforaminal epidural injection is performed unilaterally or bilaterally at one vertebral level, use CPT code 64479 or 64483 for the first level injected. If a second level is injected unilaterally or bilaterally, use CPT code 64480 or 64484.


Explanation of Revision: Annual 2011 HCPCS Update. Revised descriptors for CPT codes 64479, 64480, 64483 and 64484 in LCD. The effective date of this revision is based on date of service.


Coverage Indications, Limitations, and/or Medical Necessity

    Epidural injections are used for the treatment of multiple different conditions in chronic and acute pain. Epidural injections may be used for therapeutic and/or diagnostic purposes. There are multiple approaches to epidural injections including caudal, translaminar, and transforaminal. These different approaches are used for different but specific indications. (In general it is felt that the closer the injection can be placed to the pathology the more likely to achieve a beneficial response). Correct placement is best confirmed by using fluoroscopic guidance and injection of contrast.

    Epidural injections and/or infusions will be considered medically reasonable and necessary for the following conditions:

    1. Management of pain caused by intervertebral disc disease with or without myelopathy.

    2. Management of pain caused by spinal stenosis.

    3. Management of intractable radicular pain due to postlaminectomy syndrome/failed back syndrome.

    4. Management of intractable pain due to complex regional pain syndrome.

    5. Management of intractable pain due to post herpetic neuralgia and acute herpes zoster.

    6. Management of intractable pain due to traumatic neuropathy of the spinal nerve roots.

    7. Management of intractable and severe pain secondary to neuropathy from other causes (e.g., diabetic or metabolic).

    8. Management of severe, intractable pain in patients with advanced stages of cancer with estimated life expectancy of 4 months or less.

    9. Management of pain caused by radiculitis (inflammation of the nerve roots).

    Low back pain may also be produced by “Myofascial Pain Syndrome” in which case there is not nerve root pathology and epidural injections are not reasonable and necessary. If there is a doubt in the differential diagnosis, the diagnosis of radiculopathy can be confirmed by an EMG/nerve conduction/small fiber testing or appropriate radiological study. Degenerative Disk Disease without root compression has been shown to be a significant cause of low back and/or radicular pain; some patients will respond to Epidural Steroid Injection in this situation.

    Epidural injections, with the exception of interlaminar injections, should be performed under fluoroscopic or CT-guided imaging. Therefore, injections for chronic pain performed without imaging guidance are considered not medically reasonable or necessary.



CPT/HCPCS Codes
   
    For Single Injection     Group 1 Codes
    62310 Inject spine cerv/thoracic
    62311 Inject spine lumbar/sacral

    For Transforaminal Epidural Injections     Group 2 Codes

    64479 Inj foramen epidural c/t
    64480 Inj foramen epidural add-on
    64483 Inj foramen epidural l/s
    64484 Inj foramen epidural add-on



Introduction/Injection of Anesthetic Agent (Nerve Bock), Diagnostic or Therapeutic


Fluoroscopic and computed tomographic (CT) guidance will be bundled into the 2011 editorially revised transforaminal epidural anesthetic and/or steroid injection codes 64479, 64480, 64483, 64484, as either fluoroscopic or CT guidance is required to perform these injections.

Note that ultrasound guidance is not included in the descriptor for codes 64479-64484; therefore, if ultrasound-guidance is used in place of fluoroscopic or CT guidance, one of the newly created Category III bundled ultrasound-guided transforaminal epidural injection procedure codes, 0228T-  0231T, should be reported as of January 1, 2011. Similar to the fluoroscopy and CT-guided paravertebral facet joint injection codes created in 2010, these codes are reported per level. If multiple injections are performed at a single level on the same side, the code should only be reported once.


Transforaminal Epidural Injection of Anesthetic Agent and/or Steroid (includes fluoroscopy or CT imaging guidance)*

Fluoroscopic or CT Guidance Ultrasound Guidance

Lumbar or Sacral 64483 0230T 


Bundling Issues with ESI Procedures

The 64479 code is Unbundled in the CCI Edits from code 62310 (Regular ESI procedure) in the Mutually Exclusive Table of the CCI Unbundling Material. Code 64483 is Unbundled from code 62311 (Regular ESI procedure) in the Mutually Exclusive Table of the CCI Unbundling Material. Therefore, for Medicare and other payors who observe the CCI edits, these codes are not billable together when they are performed at the SAME spinal area. If the physician does an ESI (62311) at level L5 and a Transforaminal ESI (64483) at area L4-5, the procedures are Unbundled and not both billable – only code 62311 would be billable in that case. However, if the physician does an ESI (62311) at level L5 and a Transforaminal ESI (64483) at area L3-4, then it is allowable to put a -59 Modifier on the 64483 code and bill it as the 2nd code following the 62311 ESI code on the claim form.

Wednesday, September 21, 2016

CPT CODE 64450, 64415

cpt code and description

64450 - Injection, anesthetic agent; other peripheral nerve or branch - average fee amount - $80 - $100

64415 - Injection, anesthetic agent; brachial plexus, single Average fee amount - $110 - $130

Injections for Post-Operative Pain Control

When a patient is to receive an Injection or has a Catheter placed during an Arthroscopic Shoulder surgical procedure for control of post-operative pain, there are certain requirements which must be met in order to bill the   injection/Catheterization procedure separately.


o Do not bill to Medicare.

o The Injection/Catheterization procedure must be performed by a different physician (usually the anesthesiologist) from the surgeon who performs the ortho.

scope surgery.

o There must be a separate Procedure Report for the Post-Op Injection/ Catheterization procedure (it cannot be part of the surgeon’s OP Report or part of the Anesthesia Record).

o The Block must not be the only anesthesia for the case.

o If there is a separate report for the Injection/Catheterization procedure and the Injection/Catheterization procedure was performed by a different physician, you may bill for the Injection/Catheterization procedure. Use a different claim form from the Shoulder surgery procedure and bill the Injection/Catheterization procedure claim in the name of the anesthesiologist (or other physician) who performed the Injection/Catheterization procedure.

o Codes for billing Injection/Catheterization Shoulder post-operative pain procedures:

1. 64415 – Brachial Plexus Block (also use this code for an Interscalene Block) for a Single Injection OR

2. 64416 – Brachial Plexus Infusion by Catheter using a Pain Pump Medicare has issued specific guidance that in most cases they consider Injections performed routinely for Post-Operative Pain Control to be bundled into the orthopedic surgeon’s global services (even when the Injection is performed by a different physician), so we would recommend not billing them to Medicare.

If Injections are given for Post-Op Pain Control after Knee Surgery, the 64447 code for a Femoral Nerve Block Injection or code 64448 for a Femoral Block by Catheter using a Pain Pump would be used. Use code 64450 for Blocks for Ankle and Foot procedures.


For example, when an avulsion of a nail plate (CPT code 11730) is performed, anesthesia may be provided by the surgeon using a digital nerve block (CPT code 64450). Because this type of anesthesia provided by the surgeon performing the procedure is not separately payable, CPT code 64450 is bundled into CPT code 11730 when the same physician performs both procedures



For example, when a small joint or bursa arthrocentesis, aspiration and/or injection (CPT code 20600) is performed, anesthesia may be provided by the surgeon using a digital nerve block (CPT code 64450). Because this type of anesthesia provided by the surgeon performing the procedure is not separately payable, CPT code 64450 is bundled into CPT code 20600 when the same physician performs both procedures.

We require supporting clinical documentation in the use of Modifier 59 for a group of select National Correct Coding Initiatives (NCCI) edits. The documentation should substantiate the use of Modifier 59 in requesting separate reimbursement. This documentation should be supplied with the initial claim. We are adding 49 code pairs to the existing list. The code pairs that are being added are:

Denied Code Paid Code

64415 00450 64416 01630 64445 01480 64448 01480
64415 01400 64416 01638 64447 01320 64450 01400
64415 01480 64416 01710 64447 01392 64450 01402
64415 01610 64416 01740 64447 01400 64450 01464
64415 01620 64416 01810 64447 01402 64450 01470
64415 01630 64416 01830 64447 01464 64450 01472
64415 01638 64445 01320 64447 01470 64450 01480
64415 01710 64445 01392 64447 01472 64450 01630
64415 01740 64445 01400 64447 01480 64450 01810
64415 01810 64445 01402 64448 01320 64450 01830
64415 01830 64445 01464 64448 01392
64416 00450 64445 01470 64448 01400
64416 01610 64445 01472 64448 01402


Thursday, September 15, 2016

CPT CODE 99143, 99144 AND 99145

CPT CODE and Description

99143 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time

99144 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time

99145 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; each additional 15 minutes intra-service time



Policy: The anesthesia payment policy in Pub. 100-04, chapter 12, section 50 is being revised so that it is consistent with the pricing of the conscious sedation codes under the Medicare physician fee schedule and CPT coding guidelines. The new policy is as follows:

If the physician performing the procedure also provides moderate sedation for the procedure, then payment may be made for conscious sedation consistent with CPT guidelines. If the physician performing the procedure also provides local or minimal sedation for the procedure, then no separate payment is made for the local or minimal sedation service. The carrier shall follow the NCCI edits imposed for codes 99143 and 99144 if billed with any procedure in Appendix G of the CPT.


The CPT includes Appendix G, Summary of CPT Codes That Include Moderate (Conscious) Sedation. This appendix lists those procedures for which moderate (conscious) sedation is an inherent part of the procedure itself. CPT coding guidelines instruct practices not to report CPT codes 99143 to 99145 in conjunction with codes listed in Appendix G. The National Correct Coding Initiative has established edits that bundle CPT codes 99143 and 99144 into the procedures listed in Appendix
G.

Three of these codes (99143, 99144, and 99145) describe the scenario in which the same physician performing the diagnostic or therapeutic procedure provides the moderate sedation, and an independent trained observer’s presence is required to assist in the monitoring of the patient’s level of consciousness and physiological status. The other three codes (99148, 99149, and 99150) describe the scenario in which the moderate sedation is provided by a physician other than the one performing the diagnostic or therapeutic procedure.



CR 5618 presents some specific points that you should be aware of:

• CPT coding guidelines for conscious sedation codes instruct practices not to report Codes 99143 to 99145 in conjunction with the codes listed in CPT Appendix G. Your carrier or A/B MAC will follow the National Correct Coding Initiative, which added edits in April 2006 that bundled CPT codes 99143 and 99144 into the procedures listed in Appendix G (There are no edits for code 99145; it is an add-on-code and it is not paid if the primary code is not paid.).


BCBS Guidelines

Coverage of IV moderate sedation is appropriate for patients undergoing surgical or endoscopic procedures when general, local, or regional anesthesia is not the more appropriate choice. These decisions are based on the patient's medical  condition, age, and the type of procedure.

Reimbursement for moderate sedation is built into the compensation valuation for many  procedures. The oversight of the physician is inherent in the procedure allowance and the staff time is inherent in the facility allowance. Therefore, moderate sedation by the physician performing the procedure is not separately reimbursed (CPT codes 99143, 99144, 99145).


Coding:

99144 (NOT SEPARATELY REIMBURSED)


• The sedation service must be medically necessary for the management of the patient. Preliminary data analysis of claims submitted for these services indicates that CPT codes 99144–99145 are being billed with routine injection services and other minor procedures for which moderate sedation may not be “reasonable.” Title XVIII of the Social Security Act, Section 1862(a)(1)(A), states “... No payment may be made under Part A or Part B for any expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”

• Report only the time of face-to-face physician contact, starting with the time when the physician starts the anesthesia to the time the physician breaks face-to-face contact. The reported time stops when the physician breaks face-to-face contact, even if the trained observer stays for a longer period of time to monitor recovery. The additional time the trained observer stays to monitor recovery after the physician leaves the patient’s bedside is not a service separately billable to Medicare. The Medicare “incident to” provisions do not apply to this service since the service is defined in terms of face-to-face physician time.

• These codes may not be used to report a level of anesthesia lower in intensity than moderate or conscious sedation such as local or topical anesthesia or minimal sedation.

• For this service, Medicare defines a “physician” as an MD, DO or other physicians and non-physician practitioners licensed by the state to perform conscious sedation in addition to the diagnostic or therapeutic service for which sedation is required.


moderate/Conscious Sedation - Time Examples 

Below are some examples of moderate/conscious sedation time. ** 1 - 15 minutes of intraservice time = No CPT code assigned as the mid-point has not been reached;

service included in the E/M level.

** 16 - 37 minutes of intraservice time = Code for 1st 30 minutes

** 38 - 52 minutes = Code for 1st 30 minutes + 1 unit of the each additional 15 minutes code (i.e., 99144, 99145)

** 53 - 67 minutes = Code for 1st 30 minutes + 2 units of the each additional 15 minutes code (i.e., 99144, 99145, 99145)

** 1 hr, 20 minutes - Codes for 1st 30 minutes + 3 units of the each additional 15 minutes code (i.e., 99144, 99145, 99145, 99145)

In closing, Moderate Sedation Services are frequently provided in the Emergency Department setting. Emergency Department Physicians should familiarize themselves with the time measurement changes to the Moderate Sedation codes as these changes directly affect coding and billing. It is required that the physician document the length of intra-service time providing Moderate Sedation Services. Without a time statement these services are not billable because the coder cannot assume that the minimum time threshold of 16 minutes has been met.

Tuesday, September 13, 2016

Anesthesia Billing Guidelines Reminder and Reference



The following is a reminder of the billing guidelines for anesthesia services for  UnitedHealthcare Community Plan:

 Anesthesia Services - General or monitored anesthesia management services must be
submitted with a CPT anesthesia code 00100-01999, except 01953 and 01996. Refer to
the Anesthesia Management Codes in the Anesthesia Policy for all applicable codes.

 Time Reporting – Consistent with Centers for Medicaid & Medicare Services (CMS)
guidelines, time-based anesthesia services must be reported with anesthesia time in oneminute increments. For example, if the anesthesia time is one hour, then 60 minutes
should be submitted.

 Anesthesia Modifiers – All services reported for anesthesia management must be
submitted with the appropriate HCPCS modifiers. These modifiers identify monitored
anesthesia and whether a procedure was personally performed, medically directed or
medically supervised. Consistent with CMS guidelines, the allowance will be adjusted by
the modifier percentage indicated in the table in the Anesthesia Policy.

Claims not submitted per the Anesthesia Policy are subject to denial.

Thursday, September 8, 2016

Basic things on anesthesia billing

 Anesthesia Billing 

When a physician bills for anesthesia services, the correct procedure code and modifiers indicate one of the following below:

1. Services were personally provided by the physician to the individual patient - No modifier is needed; or

2. The physician provided medical direction for CRNA services and the number of concurrent services directed.

Anesthesiologists: The following modifiers must be used by the anesthesiologist when claiming medical direction of CRNA's:

AA - Anesthesia services performed personally by anesthesiologist

QY - Medical direction of one certified registered nurse anesthetist (CRNA) by an  anesthesiologist

Note: This is paid as a physician service. If both a CRNA and an anesthesiologist are involved in the same procedure, only the anesthesiologist is paid.

QK - Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals

Claims for these services must indicate actual time in one-minute increments in Field 24 G. All claims must be one-line claims. (For example, when Field 24 D, description of service, indicates "1" hour and 30 minutes, Field 24 G should be 90). The physician's personal services, up to and including induction, are considered the professional component. For induction only, the physician claims only one unit of anesthesia.

Anesthesia time begins when the anesthesiologist is personally in control of the patient in the operating room or equivalent area, and ends when the patient may be safely placed under post-operative supervision and the physician is   no longer in attendance.

Certified Registered Nurse Anesthetists (CRNA's): Enter the anesthesia procedure code (00100-01999). The CRNA may bill directly, or through the physician employer or hospital (all must billed on Form CMS-1500). Exception: Rural hospitals that have been exempted by their Medicare intermediary for CRNA billing must follow the Medicare billing requirements.

The following modifiers must be used by CRNA's when claiming anesthesia services:

QX - CRNA service: with medical direction by a physician

QZ - CRNA service: without medical direction by a physician

Claims for these services must indicate actual time in one-minute increments in Field 24 G. For example, when Field 24 D indicates "1 hour and 30 minutes," Field 24 G should be 90.
Anesthesia time begins when the CRNA is personally in control of the patient in the operating room or equivalent area, and ends when the patient may be safely placed under post-operative supervision and the CRNA is no longer in attendance.

Claim payments will be calculated by adding the unit value for the procedure to the number of minutes for the procedure and multiplying by the appropriate conversion factor for each code with the appropriate modifier.

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