Wednesday, July 7, 2010

Medical anesthesia billing policy

ASA Physical Status Class 3

For a patient with severe systemic disease, ASA Physical Status
Class 3 (for example, severe essential hypertension or severe chronic obstructive pulmonary disease), use modifier -P3.


ASA Physical Status Class 4 Non-Emergency

For a patient with severe systemic disease that is a constant threat to life, ASA Physical Status Class 4 (for example, severe chronic congestive heart failure, chronic severe neutropenia, or unstable angina), use modifier -P4.

ASA Physical Status Class 4 Emergency

For a patient in ASA Physical Status Class 4 who requires emergency surgery (for example, acute appendicitis with severe thrombocytopenia needing emergency operation), use modifier -ZD.


ASA Physical Status Class 5  Emergency

For a patient who is moribund and not expected to survive without the operation, ASA Physical Status Class 5, and requires emergency surgery, use modifier -P5 with -ET.

Non-Benefit Conditions:
Modifiers -P3, -P4,-P5 with -ET, and -ZD

These modifiers do not apply and may not be billed to Medi-Cal when anesthesia is provided for procedures clearly directed toward treatment of the systemic disease or its complication, or where the service is implicitly represented in the basic anesthesia value.  For example, these modifiers are not appropriate to indicate the presence of arteriosclerotic heart disease or a coronary artery disease where anesthesia for a coronary artery bypass is billed.

    Medi-Cal will not reimburse providers for these modifiers in cases involving such general diagnoses as obesity, diabetes mellitus, hypertension or anemia.  These modifiers are allowed only when the specific medical condition of the individual patient is adequately documented to meet the modifier’s definition.  They also may not be billed simply because of the patient’s age or nutritional status.

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