Wednesday, June 9, 2010

Physical status modifier for Anesthesia billing

ANESTHESIA MODIFIERS- Utah Medicaid


Report all anesthesia with the anesthesia five-digit procedure code (00100 through 01999) plus the addition of a physical status modifier. The use of other optional modifiers may be appropriate.

Physical Status Modifiers

Physical Status modifiers are represented by the initial letter “P” followed by a single digit from “1 to 6". Example: 00100-Pl
These modifiers indicate various levels of complexity of the anesthesia service provided. The Utah Medicaid values for physical status are as follows.

Modifier                        Description Medicaid                                                                              Unit Value
P1                    A normal healthy patient                                                                                                    0
P2                   A patient with mild systemic disease                                                                                 1
P3                   A patient with severe systemic disease                                                                             3
P4          A patient with severe systemic disease that is a constant threat to life                                4
P5          A moribund patient who is not expected to survive without the operation                         6
P6       A declared brain-dead patient whose organs are being removed for donor purpose            0


When billing for anesthesia , indicate the appropriate physical status modifier. If no physical status is indicated, the Medicaid Management Information System (MMIS) assumes the physical status is P1 - a normal healthy patient. If a Physical Status Modifier is billed, MMIS automatically calculates additional payment. Utah Medicaid has not required the use of the “unique” Utah Medicaid Modifier 30 since February 1, 1995. However, if this modifier is billed, MMIS will accept 30 as a valid modifier.

Anesthesia Where Modifying Units Are Not Applicable
General consultation, limited
General consultation, comprehensive
Convulsive therapy with anesthesia
Cardiopulmonary resuscitation
Respirator care, consultation and therapy
Intensive care of acutely ill patient (while anesthesiologist is in personal attendance)
Daily visits (follow-up acutely ill, maximum two days)
Psychotherapy, verbal, drug augmented or other methods
Electrical cardioversion
Nerve blocks as listed


Other Modifiers

Under certain circumstances, medical service and procedures may need to be further modified. Other modifiers commonly used are:

22 Unusual Procedural Services
24 Unrelated Evaluation and Management Service during the Post-operative period (used for pain
management)
23 Unusual Anesthesia
51 Multiple Procedures
53 Discontinued Procedure
59 Distinct Procedural Service

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