Monday, June 14, 2010

Payment for multiple procedure - Utah Medicaid

MULTIPLE PROCEDURES - Utah Medicaid - Anesthesiology

When multiple procedures are performed during a single anesthetic administration, Medicaid’s policy is to pay the basic value for only one anesthesia procedure. It is suggested that providers select the ASA procedure code with the highest basic value. Obstetrical anesthesia is an exception to this policy.


Multiple Obstetrical Procedures

For dates of service on or after January 1, 2002, anesthesia for multiple obstetrical procedures may be paid the basic values for both procedures in the following circumstances:

• Neuraxial analgesia/anesthesia for planned vaginal delivery which becomes a Cesarean delivery.
Code 01967 to begin the procedure.
When C-section is imminent, discontinue use of 01967 and change to ----
Code 01968 and continue on with straight time as for a general surgery.

• Neuraxial analgesia/anesthesia for planned vaginal delivery followed by tubal ligation on same or
the next day following delivery.
Code 01967 for delivery
Code 00851 (new code) Intraperitoneal Lower Abdomen, Tubal Ligation/Transection.

There may be other combinations of procedures which occur occasionally and will need to be reviewed for adjudication.

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