Friday, May 20, 2016

Anesthesia Services overview - For beginner - Type of Anesthesia



Services are provided by a qualified anesthesia provider to a surgical patient while in a state of analgesia or anesthesia so that surgical intervention can be undertaken. Anesthesia services consist of the administration of an anesthetic agent, typically by injection or inhalation, causing partial or complete loss of sensation, with or without loss of consciousness.

The anesthesia procedure is administered by a qualified anesthesia provider, which includes:

• Anesthesiologist (other than the operating physician, assistant surgeon, or obstetrician)

• Anesthesiologist Assistant AA

• Certified Registered Nurse Anesthetist (CRNA)

• Physicians qualified to administer general anesthesia or to appropriately supervise anesthesia professionals

• Usual preoperative and postoperative visits

• Anesthesia care during the procedure

• Administration of fluids or blood

• Usual monitoring (e.g., ECG, temperature, blood pressure, oximetry, capnography, mass spectrometry) as defined by American Society of Anesthesiologists ( ASA) and/or CPT guidelines.


According to CPT guidelines, the reporting of anesthesia services is appropriate by or under the responsible supervision of an anesthesiologist. These services may include but are not limited to general, regional, supplementation of local anesthesia, or other supportive services in order to afford the patient the anesthesia care deemed optimal by the anesthesiologist during any procedure.


Non-Covered Services

Services not covered under the terms of the member’s applicable Benefit Agreement include, but are not limited to, the following:

• Standby anesthesia – Florida Blue does not cover physicians “standing by” in anticipation of needing general anesthesia

• Anesthesia administered by operating physician or surgical resident

• Anesthesia by hypnosis

• Anesthesia by acupuncture

• Anesthesia for cosmetic surgery


Monitored Anesthesia Care

Intra-operative monitoring by an anesthesiologist, physician, or other qualified individual under the medical direction of the anesthesiologist, of the patient’s vital physiological signs in anticipation of the need for administration of general anesthesia or of the development of adverse physiological patient reaction to the surgical procedure.

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



Qualifying Circumstances

Reimbursement for qualifying circumstances for anesthesia (99100-99140) is included in the basic allowance for other anesthesia procedures (00100-01999) when performed on the same day by the same physician. No additional reimbursement is allowed for CPT codes 99100-99140.


Moderate Sedation

Florida Blue separately allows moderate sedation provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, with procedures 99143-99145 except as follows:

• 99143-99145 will not be separately reimbursed with any procedures in Appendix G (refer to Summary of CPT Codes That Include Moderate (Conscious) Sedation) based on CPT guidelines.

• 99143-99145 will not be separately reimbursed with CPT and HCPCS procedures whose verbiage contains “with anesthesia,” “under anesthesia,” “under or requiring general anesthesia,” etc. based on their verbiage and the fact that moderate sedation is not expected with these procedures.

• 99143-99145 will not be separately reimbursed when billed with radiation therapy services, based on the National Correct Coding Initiative that contains edits bundling CPT codes 99143-99144 into all radiation therapy services.

Procedure codes 99148-99150 should be used if a second physician other than the healthcare professional performing the diagnostic or therapeutic services provides the moderate sedation.

Monday, May 16, 2016

What is Qualifying Circumstances ?


Qualifying circumstances are those factors such as extreme age, extraordinary condition of the patient, and unusual risk factors which may affect the anesthesia services. These procedures are considered add-on codes and would not be reported alone, but as additional procedures qualifying an anesthesia procedure or service. These procedures must be filed with the appropriate modifier. Codes without the appropriate modifier may be returned or rejected. Do not bill these procedures with physical status modifiers or anesthesia minutes. An additional fee will be reimbursed based on the allowed units for each circumstance:


99100 – Anesthesia for Patient of Extreme Age, Under 1 Year and Over 70 – 1 unit
99116 – Anesthesia Complicated By Utilization of Total Body Hypothermia – 5 units
99135 – Anesthesia Complicated By Utilization of Controlled Hypotension – 5 units
99140 – Anesthesia Complicated – 1 unit

Q. What defines medical direction?

For each anesthesia procedure, the anesthesiologist must perform all of the following seven services and they must be recorded in the anesthesia record:

1. Perform a pre-anesthetic examination and evaluation;
2. Prescribe the anesthesia plan;
3. Personally participate in the most demanding procedures of the anesthsia plan including, if
applicable, induction and emergence;
4. Ensure that any procedure in the anesthesia plan that he or she does not perform are performed
by a qualified anesthetist;
5. Monitor the course of anesthesia administration at frequent intervals;
6. Remain physically present and available for immediate diagnosis and treatment of
emergencies; and
7. Provide all the indicated post-anesthesia care.

Sunday, May 8, 2016

How much payment would be reimbursed when modifer AA. AD, QK, QK used?

Modifier Description % of Allowed Charge

AA Anesthesia services performed personally by the anesthesiologist 100 percent
AD Medical supervision by a physician; more than four concurrent anesthesia procedures. (Three base units + actual time units allowed) 65 percent
QK Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals). 65 percent
QY Medical direction of one CRNA/AA by an anesthesiologist 65 percent
QX CRNA/AA service with medical direction by an anesthesiologist. 35 percent
QZ CRNA service without medical direction by an anesthesiologist. 70 percent


Note: Modifiers are also required for add-on codes 01953, and 01968-01969

Physical Status Modifiers

Physical status modifiers distinguish between various levels of complexity of the anesthesia service provided based on the patient’s condition and are represented by the letter P followed by a single digit. These modifiers are required for Modified Anesthesia Care (MAC).

P1 Normal healthy patient
P2 Patient with mild systemic disease
P3 Patient with severe systemic disease
P4 Patient with severe systemic disease that is a constant threat to life
P5 Moribund patient who is not expected to survive without the operation
P6 Declared brain-dead patient whose organs are being removed for donor purposes

Wednesday, April 27, 2016

Document required for Anesthesia services

Medical Direction

Medical direction occurs when an anesthesiologist is involved in two, three or four concurrent anesthesia procedures or a single anesthesia procedure with a qualified anesthetist. Payment will be determined for  the physician’s medical direction service of the allowable charge for the physician personally performing the
anesthesia services. For each anesthesia procedure, the anesthesiologist must provide the following seven services and record each in the patient’s anesthesia record:

1. A pre-anesthetic examination and evaluation;
2. Prescribe the anesthesia plan;
3. Personally participate in the most demanding procedures of the anesthesia plan including,
if applicable, induction and emergence;
4. Ensure that any procedure in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist;
5. Monitor the course of anesthesia administration at frequent intervals;
6. Remain immediately physically present and available for immediate diagnosis and treatment of emergencies; and
7. Provide the indicated post-anesthesia care.


If the above services are not performed by the anesthesiologist, the service is not considered medical direction. The anesthesiologist must document in the patient’s medical record that he or she performed the pre-anesthesia examination and evaluation. The record should also document that the anesthesiologist provided post-anesthesia and whether the anesthesiologist was present during some portion of the anesthesia monitoring or during the most demanding procedures, including induction
and emergence, where applicable.

When the anesthesiologist does not fulfill all of the “medical direction” requirements listed above, the concurrent anesthesia services are considered medical supervision services, not medical direction services.

• When an anesthesiologist is supervising more than four concurrent cases, the service should be filed as follows: anesthesiologist – “AD” and CRNA – “QX”

• When a CRNA personally performed the services without medical direction or supervision, as described above, the service should be filed as follows: CRNA – “QZ”

• AAs are always under the “medical direction” of an anesthesiologist

Ordinarily, an anesthesiologist should not furnish additional services to other patients while concurrently directing the administration of anesthesia. Benefits may be provided if the anesthesiologist provides any of the following services to other patients while medically directing the administration of anesthesia without affecting their ability to administer medical direction:

• Addressing an emergency of short duration in the immediate area, such as:

1. Labor epidural placement and management;

2. Responding to medical emergencies or urgencies of short duration (i.e., establishing intravascular access in patient whose quality of care is reduced without it, tracheal intubation, advanced circulatory life support (ACLS) provision, etc.);

• Administering an epidural or caudal anesthetic to ease labor pain;

• Administering an epidural steroid injection or trigger point injection requested by another physician. The epidural or trigger point injection may only be done in compliance with the 1:4 ratio. This does not include consults to diagnose and treat. The intent of allowing this practice is enhancement of efficiency in providing these comonly requested procedures. The intent is not to allow or encourage anesthesiologists to schedule and provide a full service chronic pain management clinic while also concurrently attempting to provide the care to patients receiving surgical anesthesia under his or her direction. The consult for performance of an epidural or trigger point may serve as the second, third, or fourth concurrent case. This means that performing limited pain services is not allowed while medically directing four concurrent anesthetics. The anesthesiologist involved is responsible for being sure his or her ability to respond to urgent or emergent needs in operating rooms, labor and delivery rooms, or any other place in the hospital where responsibility may be, is not unsafely reduced at any time;

• Periodic rather than continuous monitoring of an obstetrical patient;
• Receiving patients entering the operating suite for the next surgery;
• Checking on or discharging patients from the post anesthesia care unit; and/or
• Coordinating scheduling matters.

Thursday, April 21, 2016

Covered and non covered service - would Aneshesia consultation covered seperately ?

According to CPT guidelines, the reporting of anesthesia services is appropriate by or under the responsible supervision of a physician. These services may include, but are not limited to, general, regional and supplementation of local anesthesia or other supportive services in order to provide the patient with optimal anesthesia care during any procedure.

Covered Services

Anesthesia services may be covered only when:
• The procedure for which anesthesia is administered is a covered service under the member’s applicable Benefit Agreement; and

• Consultations rendered by an anesthesiologist for care, other than normal or uncomplicated care, may be eligible for coverage if separately identifiable services were rendered. Substantiating documentation is required for medical review of medical necessity.

Non-Covered Services

Services not covered under the terms of the member’s applicable Benefit Agreement include, but are not limited to, the following:

• Standby anesthesia – Blue Cross does not cover physicians “standing by” in anticipation of needing general anesthesia;
• Anesthesia administered by the operating physician or surgical resident;
• Anesthesia by hypnosis or acupuncture; and/or
• Anesthesia for cosmetic surgery.


Administration of Anesthesia by Operating Physician

No additional payment will be made to an operating physician for anesthesia services rendered during the course of performing a surgical procedure. Under the global guidelines, payment made to a surgeon includes payment for anesthesia administered by the operating surgeon.


Consultations

Anesthesia consultation is part of the global procedure when performed on the day of or before the procedure and is not separately billable. However, there are some circumstances when a consultation is payable:

• Anesthesiologist consults with the patient for management of chronic intractable pain; and

• Anesthesiologist performs the consultation, but no anesthesia procedure is performed. For example, time is spent in discussion with a patient, but the patient was not induced due to complications.

Wednesday, April 13, 2016

Global payment in Anesthesia services

Global Services

Global reimbursement of anesthesia administration includes the following:

• Pre-anesthesia evaluation [Physicians’ Current Procedural Terminology (CPT) codes 99201-99205, 99221-99223];

• Post-postoperative visits (CPT codes 99211-99215, 99231-99233);

• Anesthetic or analgesic administration;

Local anesthesia during surgery;

• Monitoring of electrocardiograms (EKGs), pulse breathing, blood pressure, electroencephalogram and other neurological monitoring;

• Monitoring of left ventricular or valve function via transesophageal echocardiogram (TEE);

• Monitoring of intravascular fluids (IVs), blood administration and fluids used during cold cardioplegia through non-invasive means; and

• Maintenance of open airway and ventilator measurements and monitoring.

Arterial lines and monitoring are no longer included in the global anesthesia fee. Bill for these services separately using the same major/minor guidelines that are used with surgical services, when billed with other procedures such as Swan Ganz

Thursday, April 7, 2016

Physical Status Modifiers in Aneshesia services

Here is the list of Modifiers in Anesthesia services.


P1 A normal health patient
** Informational only; does not impact payment

P2 A patient with mild systemic disease
** Informational only; does not impact payment

P3  A patient with severe systemic disease
** Informational only; does not impact payment

P4
A patient with severe systemic disease that is a constant threat to life
** Informational only; does not impact payment

P5
A moribund patient who is not expected to survive without the operation
** Informational only; does not impact payment

P6
A declared brain-dead patient whose organs are being removed for donor purposes
** Informational only; does not impact payment

PRIOR AUTHORIZATION OR THRESHOLD LIMITS


There is no prior authorization or threshold limits associated with anesthesia services