Tuesday, March 22, 2016

Some basic question on Anesthesia billing ?

Payment
The allowed amount is determined based on the anesthesia procedure that has the highest base unit value.

Base Units
Do not submit base units on the claim, they will be included in the calculation of the allowed amount.

Anesthesia Time
** Submit the exact number of minutes from the preparation of the patient for induction to the time the anesthesiologist or CRNA are no longer in personal attendance or continue to be required.
** UCare will translate the number of anesthesia minutes submitted by the provider to units of service.
** Fifteen (15) minutes of time equal one unit of service.
** Units will be calculated to one decimal point. (Example: 62 minutes / 15 = 4.1 units of service).

Additional Payment for Physical Status Modifiers
No additional payment.


Qualifying Circumstances Codes (99100 – 99140)
Reimbursement for qualifying circumstances for anesthesia is included in the basic allowance for anesthesia procedures (00100 – 01999). No additional reimbursement is for CPT Codes 99100 – 99140


Placement of central venous lines, arterial catheters, Swan-Ganz catheters
Separately billable

Surgical Procedure is cancelled

** If a case was cancelled after the pre-operative exam but prior to the patient being prepared for surgery or induction, an E/M service that appropriately represents the service should be billed.
** If a case was cancelled after induction of anesthesia, bill the case with the anesthesia CPT code for the procedure that was being rendered. Add a “53” for the tertiary modifier to indicate the discontinued procedure. Reimbursement will be based on the amount of time reported plus the base units for the discontinued procedure.

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