Monday, November 29, 2010

Anesthesia cpt codes and E & M service code

Anesthesia and E/M services

Anesthesia services are billed using CPT® codes 00100-01999.  These CPT® codes are cross-walked to surgical codes.  The crosswalk is available from the American Society of Anesthesiologists at www.asahq.org.

Each anesthesia code has a base unit assigned to it. The anesthetist also bills the number of time units, with a single unit defined as 15 minutes.  The base units plus the time units multiplied by the anesthesia conversion factor equals the fee.  Medicare has a separate conversion factor for anesthesia services.   Anesthesia codes do not have Relative Value Units.  The value of the base code includes the preoperative medical evaluation performed by the Anesthesiologist, and is not separately reportable.

Can an Anesthesiologist bill for an E/M service prior to the actual anesthesia service?

Anesthesia codes and E/M codes are bundled per the NCCI edits, and may not be reported together with any modifier.  That is: the preoperative E/M evaluation is part of the payment to the Anesthesiologist for the anesthesia service, and is included in the base code payment.

Could a hospital employ an NPP to do an E/M service prior to the anesthesia for high risk patients?

A hospital, which employed Non-Physician Practitioners to run a pre-operative anesthesia clinic would be collecting money for services that should have been provided without additional charge by the Anesthesiologist.  (Had the Anesthesiologist employed the NPPs and used a pre-operative diagnosis code for the service, all claims would be denied as part of the Anesthesia payment.)  The claims might be paid because the payer’s claims processing system does not associate them with the Anesthesia group, but it would be money the hospital wasn’t entitled to collect.  In addition to collecting money to which it is not entitled, the hospital also runs the risk of appearing to support a for-profit physician group, by providing services for free which should be the expense of the group.

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