Thursday, June 10, 2010

REIMBURSEMENT FOR ANESTHESIA - Utah Medicaid

REIMBURSEMENT FOR ANESTHESIA - Utah Medicaid

Anesthesia is a global service just as the surgical procedure for which it is given. No pre or postoperative services will be recognized for separate payment, including those for:

a. For pain management on the same day as C-section, see section 3-6 and 9-1, Post-Operative
Pain Management Policy.

b. The code 95955, electroencephalogram (EEG) during non intra cranial surgery, may be used for
BSI. Bispectral index monitoring (BSI) is used by anesthesia to monitor the level of anesthesia
which will reduce the risk of patient awareness. The code 95812 and code 95822 may also be
used to provide EEG monitoring. Routine monitoring, including EEG monitoring is included within
the primary anesthesia and not reimbursed separately. Neurological monitoring is considered
included within neuroanesthesia procedures. Code 95925, 95926, 95927, 95928, 95929, 95930,
and 95937 will produce an incidental denial in the editing program with anesthesia services that
may warrant this type of monitoring.

c. Larygnoscopy codes 31505, 31515, and 31527 are incidental or included within the anesthesia
time.

Anesthesia payments will be the lower of billed charges or a calculated fee. The Medicaid Management Information System (MMIS) calculates anesthesia reimbursement by adding Basic Value, plus Modifying Units (if any), plus Time Units and multiplying the total number of “anesthesia values” by a dollar conversion factor.

The Basic Value assigned to the anesthesia code includes the pre-operative and post-operative care. Medicaid does not reimburse for two Basic values on the same date of service. When a patient has to return to surgery on the same date for complications, the provider is instructed to add the additional time required for the second surgery to the primary anesthesia code.

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