Friday, July 30, 2010

Anesthesia billing when teaching physician involved with example

Teaching Physician

Medicare pays an unreduced fee schedule payment if a teaching anesthesiologist is involved in a single procedure with one resident. The teaching physician must document in the medical records that he was present during all critical or key portions of the procedure. The teaching physician’s physical presence during only the preoperative or postoperative visits with the beneficiary is not sufficient to receive Medicare payment. If an anesthesiologist is involved in concurrent procedures with more than one resident or with a resident and a non-physician anesthetist, and the service is furnished prior to January 1, 2010, Medicare pays for the anesthesiologist’s services as medical direction.

In those cases where the teaching anesthesiologist is involved in two concurrent anesthesia cases with residents on or after January 1, 2004, the teaching anesthesiologist may bill the usual base units and anesthesia time for the amount of time he is present with the resident. The anesthesiologist can bill base units if he is present with the resident throughout pre- and post-anesthesia care. The anesthesiologist should use the AA modifier to report such cases. The teaching anesthesiologist must document his involvement in cases with residents. The documentation must be sufficient to support the payment of the fee and available for review upon request.

For anesthesia services furnished on or after January 1, 2010, payment may be made under the Medicare physician fee schedule at the regular fee schedule level if the teaching anesthesiologist is involved in the training of a resident in a single anesthesia case, two concurrent anesthesia cases involving residents, or a single anesthesia case involving a resident that is concurrent to another case paid under the medical direction rules. To qualify for payment, the teaching anesthesiologist, or different anesthesiologists in the same anesthesia group, must be present during all critical or key portions of the anesthesia service or procedure involved. The teaching anesthesiologist (or another anesthesiologist with whom the teaching physician has entered into an arrangement) must be immediately available to furnish anesthesia services during the entire procedure. The documentation in the patient’s medical records must indicate the teaching physician’s presence during all critical or key portions of the anesthesia procedure and the immediate availability of another teaching anesthesiologist as necessary.

If different teaching anesthesiologists are present with the resident during the key or critical periods of the resident case, the National Provider Identifier (NPI) of the teaching anesthesiologist who started the case must be indicated in the appropriate field on the claim form or electronic equivalent.

The teaching anesthesiologist should use the AA modifier and the GC certification modifier to report such cases.

Modifier

GC  - These services have been performed by a resident under the direction of a teaching physician

Examples:
If the teaching physician is involved in a single anesthesia procedure with one resident, the teaching physician should bill his services with the AA and GC modifiers.

If the teaching physician is involved in two concurrent anesthesia cases with two residents on or after January 1, 2004, the teaching anesthesiologist may bill the usual base units and anesthesia time for the amount of time he is present with residents. The teaching physician should bill the services to Medicare for his services with the AA and GC modifiers.

When filing claims to Medicare, the teaching physician should use the anesthesia modifier first (the payment modifier), followed by the GC modifier. By submitting the GC modifier, the teaching anesthesiologist is indicating he has been present during all critical or key portions of a single anesthesia procedure or concurrent anesthesia procedure.

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