Friday, July 22, 2016

Anesthesia billing Which form to use

A. GENERAL BILLING INFORMATION 

Electronic (EDI) HIPPA 5010 compliant 837P format claim submission - Submit total time in minutes in the appropriate field

Paper claim submission 

- Submit claim using the most current CMS-1500 form. 
- Submit total minutes in the unit field.
- Submit actual start and stop time (ex. 12:00 to 13:00 or 12:00 pm to 1:00 pm) on the claim form above the anesthesia CPT code field.

All claims for anesthesiologists and CRNAs must be billed under the name and National Provider Identifier (NPI) of the provider who actually rendered the service. “Incident to” billing for anesthesia services is not recognized by Neighborhood. All providers should render services based on the scope of their particular license.


Anesthesia Service Codes *not an all-inclusive list 

CPT Code - 00100 to 00936, 00940 to 01999, 62273, 99100 to 99150
HCPCS Code - D9220, D9221 (D-codes only covered for oral surgery)



Monday, July 18, 2016

CPT code 01952, 01996

Anesthesia for Burns

CPT code 01952 is the primary code for billing Anesthesia for Second and Third Degree Burn Excision or Debridement With or Without Skin Grafting. The add-on CPT code 01953 is not considered an anesthesia management service and should not be reported with time. CPT code 01953 may be reported with units of service up to a maximum of 10. This procedure will be paid from the fee schedule rather than the anesthesia calculation with time and base units. CPT code 01952 and addon code 01953 must be filed with the appropriate modifier in the first position.

Nerve Blocks When introduction or injection of anesthetic agent is administered the anesthetic agent is included in the payment for the actual procedure and not separately billable.


Epidural Catheters Intractable Pain

For control of intractable pain that is resistant to conventional forms of therapy (i.e., physical therapy, TENS units, etc.) payment may be allowed for the placement of a catheter. In addition, CPT code 01996 (daily management) may be billed on a daily basis as long as an identifiable service is being rendered by the anesthesiologist, CRNA or AA and deemed medically necessary and within the scope of their license. CPT code 01996 is not allowed on the same day as placement of an epidural catheter.

Sunday, July 10, 2016

Anesthesia and Medical/Surgical Service Provided by the Same Physician


Anesthesia services range in complexity. The continuum of anesthesia services, from least intense to most intense in complexity is as follows: local or topical anesthesia, moderate (conscious) sedation, regional anesthesia and general anesthesia. Prior to 2006, Medicare did not recognize separate payment if the same physician provided the medical or surgical procedure and the anesthesia needed for the procedure.

Moderate sedation is a drug induced depression of consciousness during which the patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Moderate sedation does not include minimal sedation, deep sedation or monitored anesthesia care. In 2006, the CPT added new codes 99143 to 99150 for moderate or conscious sedation. The moderate (conscious) sedation codes are carrier priced under the Medicare physician fee schedule.

The CPT codes 99143 to 99145 describe moderate sedation provided by the same physician 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. The physician can bill the conscious sedation codes 99143 to 99145 as long as the procedure with it is billed is not listed in Appendix G of CPT. CPT codes 99148 to 99150 describe moderate sedation provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports.

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.

In the unusual event when a second physician other than the health care professional performing the diagnostic or therapeutic services provides moderate sedation in the facility setting for the procedures listed in Appendix G, the second physician can bill 99148 to 99150. The term, facility, includes those places of service listed in Chapter 23
Addendum -- field 29. However, when these services are performed by the second physician in the nonfacility setting, CPT codes 99148 to 99150 are not to be reported.

If the anesthesiologist or CRNA provides anesthesia for diagnostic or therapeutic nerve blocks or injections and a different provider performs the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using CPT code 01991. The service must meet the criteria for monitored anesthesia care. If the anesthesiologist or CRNA provides both the anesthesia service and the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using the conscious sedation code and the injection or block. However, the anesthesia service must meet the requirements for conscious sedation and if a lower level complexity anesthesia service is provided, then the conscious sedation code should not be reported.

If the physician performing the medical or surgical procedure also provides a level of anesthesia lower in intensity than moderate or conscious sedation, such as a local or topical anesthesia, then the conscious sedation code should not be reported and no payment should be allowed by the carrier. There is no CPT code for the performance of local anesthesia and as payment for this service is considered in the payment for the underlying medical or surgical service.

Thursday, July 7, 2016

When to use Modifier 59, 73, 74 IN Anesthesia billng?

59 Distinct Procedural Service — Services with modifier 59 may be subject to review of medical records. Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Modifier 25 should be used only if a more descriptive modifier is not available, and the use of modifier 59 best explains the circumstances. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.

73 Discontinued Outpatient Hospital/ASC procedure prior to the administration of anesthesia — Due to extenuating circumstances or those that threaten the wellbeing of
the patient, the physician may cancel a surgical or diagnostic procedure subsequent to  the patient’s surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be performed), but prior to the administration of anesthesia [local, regional block(s) or general]. Under these circumstances, the intended service that is prepared for but cancelled can be reported by its usual procedure code and the addition of modifier 73. Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.


74 Discontinued Outpatient Hospital/ASC procedure after the administration of anesthesia — Due to extenuating circumstances or those that threaten the wellbeing of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia [local, regional block(s), general] or after the procedure was started (incision made, intubation started, scope inserted, etc.). Under these circumstances, the procedure started but terminated can be reported by its usual procedure code and the addition of modifier 74. Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.

Sunday, July 3, 2016

Definition of Concurrent Medically Directed Anesthesia Procedures with time calculation example



Concurrency is defined with regard to the maximum number of procedures that the physician is medically directing within the context of a single procedure and whether these other procedures overlap each other. Concurrency is not dependent on each of the cases involving a Medicare patient. For example, if an anesthesiologist directs three concurrent procedures, two of which involve non-Medicare patients and the remaining a Medicare patient, this represents three concurrent cases. The following example illustrates this concept and guides physicians in determining how many procedures they are directing.

EXAMPLE

Procedures A through E are medically directed procedures involving CRNAs and furnished between January 1, 1992 and December 31, 1997 (1998 concurrent instructions can be found in subsection C.) The starting and ending times for each procedure represent the periods during which anesthesia time is counted. Assume that none of the procedures were cataract or iridectomy anesthesia.

Procedure A begins at 8:00 a.m. and lasts until 8:20 a.m.
Procedure B begins at 8:10 a.m. and lasts until 8:45 a.m.
Procedure C begins at 8:30 a.m. and lasts until 9:15 a.m.
Procedure D begins at 9:00 a.m. and lasts until 12:00 noon.
Procedure E begins at 9:10 a.m. and lasts until 9:55 a.m.

Procedure  Number of Concurrent Medically Directed Procedures  Base Unit Reduction Percentage

A 2  10%
B 2 10%
C 3 25%
D 3 25%
E 3 25%

From 8:00 a.m. to 8:20 a.m., the length of procedure A, the anesthesiologist medically directed two concurrent procedures, A and B.


From 8:10 a.m. to 8:45 a.m., the length of procedure B, the anesthesiologist medically directed two concurrent procedures. From 8:10 to 8:20 a.m., the anesthesiologist medically directed procedures A and B. From 8:20 to 8:30 a.m., the anesthesiologist medically directed only procedure B. From 8:30 to 8:45 a.m., the anesthesiologist medically directed procedures B and C. Thus, during procedure B, the anesthesiologist medically directed, at most, two concurrent procedures.
From 8:30 a.m. to 9:15 a.m., the length of procedure C, the anesthesiologist medically directed three concurrent procedures. From 8:30 to 8:45 a.m., the anesthesiologist

medically directed procedures B and C. From 8:45 to 9:00 a.m., the anesthesiologist medically directed procedure C. From 9:00 to 9:10 a.m., the anesthesiologist medically directed procedures C and D. From 9:10 to 9:15 a.m., the anesthesiologist medically directed procedures C, D and E. Thus, during procedure C, the anesthesiologist medically directed, at most, three concurrent procedures.

The same analysis shows that during procedure D or E, the anesthesiologist medically directed, at most, three concurrent procedures.

Wednesday, June 29, 2016

Anesthesia Time calculation for personally performed and Medical direction

According to CPT guidelines, anesthesia time begins when the anesthetists begins to prepare the patient in the operating room or in an equivalent area and ends when the anesthetist is no longer in personal attendance and the patient may be safely placed under post-anesthetic supervision. Anesthesia time should be reported in minutes. Effective for dates of service on or after January 1, 2014, for all Anesthesiologists, CRNAs and AAs, one unit of time will be allowed for each 15 minute increment of anesthesia or a fraction thereof.

Reimbursement for time based anesthesia is based on the following formulas:

Anesthesia Personally Performed by Anesthesiologist or CRNA (AA or QZ Modifier)
(Base Factor + Total Time Units) x Anesthesia Conversion Factor x Modifier Adjustment = Allowance

Anesthesia Performed under Medical Direction (QK, QX and QY modifiers)
[(Base Factor + Total Time Units) x Anesthesia Conversion Factor] x Modifier Adjustment = Allowance for each provider

Anesthesia “base unit” is the number of units assigned for the anesthetic management of surgical procedures using nationally recognized anesthesia base value standards. Base units are automatically calculated and should not be reported on the claim form. Blue Cross will utilize the CMS base unit values.

Anesthesia time should be submitted on the claim as total minutes. For example, one hour and nine minutes of anesthesia time is billed as 69 minutes. Blue Cross then converts minutes into 15-minute increments. This calculation would be four 15 minute time units and 9/15 of one unit. Total time units for this example are 4.6.

Blue Cross recognizes that the patient must be prepared immediately prior to induction and that some time may be spent immediately after the conclusion of the surgical procedure. Generally, no more than one unit should be necessary to prepare the patient for post-operative transfer to the recovery room. It is inappropriate to bill for anesthesia time while the patient is waiting in a holding area. If it is necessary for a more extensive service to be provided, documentation must be provided in the patient’s medical record to substantiate medical necessity. It is inappropriate to bill time units for services such as administration of blood products or antibiotics in the holding area, when such services could be provided in another area of the hospital or facility.

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.