Saturday, May 29, 2010

how BCBS calculate payment for Aneshthesia billing?

Anesthesia Payment & Billing Information - BCBS

Payment Calculation Information
Time Units  :

Time units will be determined by using the total time in minutes actually spent performing the procedure. Fifteen minutes is equivalent to one (1) time unit. Time units will be rounded to the tenth. Therefore, if the procedure lasted 49 minutes, the time units in this example would be 3.26 or 3.3 time units. The units field 24G of the HCFA form should reflect the number of minutes the provider spent on the procedure, (e.g. one hour-thirty minutes should be reflected as (90) in the units field).

Anesthesia time begins when the provider of services physically starts to prepare the patient for induction of anesthesia in the operating room (or equivalent) and ends when the provider of services is no longer in constant attendance and the patient may safely be placed under postoperative  supervision.


Base Points:

The basis for determining the base points is the Relative Value Guide published by the American Society of Anesthesiologists (ASA). HMO Blue Texas and Blue Cross and Blue Shield of Texas shall implement any yearly update of the Relative Value Guide within 60 days of receipt. Base points used to process claims will be the base points in effect on the date(s) Covered
Services are rendered. The exception to this will be Covered Services provided on dates between the receipt of the Relative Value Guide published by ASA and implementation of the updated material. Claims incurred during the exception period will be priced based on the Relative Value Guide in effect on December 1st of the prior calendar year. Newly established codes will be paid at HMO Blue Texas and Blue Cross and Blue Shield of Texas determined rates until the annual update is implemented.




Physical Status Modifiers – to be billed by anesthesiologists and/or CRNAs :




                                                                                                                             Unit Values (s)
P1 - A normal healthy person                                                                                    0
P2 - A patient with mild systemic disease                                                                0
P3 - A patient with severe systemic disease                                                             1
P4 - A patient with severe systemic disease that is a constant threat                 2
to life

P5 - A moribund patient who is not expected to survive without the                    3
operation

P6 - A declared brain dead patient whose organs are being removed  
for donor purposes                                                                                                       0




Qualifying Circumstances – to be billed by anesthesiologists and/or CRNAs  :


99100 - Anesthesia for patients of extreme age, under 1 year and over 70 (list separately in
addition to code for primary procedure)
Unit value : 1

99116 - Anesthesia complicated by utilization of total body hypothermia (list separately in
addition to code for primary procedure)
Unit value : 5


99135 - Anesthesia complicated by utilization of controlled hypotension (list separately in
addition to code for primary procedure)
Unit value : 5


99140 - Anesthesia complicated by emergency conditions (specify) (list separately in addition to
code for primary procedure)
Unit value : 2




Payment Calculation :


Time units plus base points plus unit value(s) allocated to physical status modifiers and/or qualifying circumstances listed above (if applicable) equals “Y”. Allowable amount equals the anesthesia conversion factor multiplied by “Y”.




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