Thursday, April 21, 2016

Covered and non covered service - would Aneshesia consultation covered seperately ?

According to CPT guidelines, the reporting of anesthesia services is appropriate by or under the responsible supervision of a physician. These services may include, but are not limited to, general, regional and supplementation of local anesthesia or other supportive services in order to provide the patient with optimal anesthesia care during any procedure.

Covered Services

Anesthesia services may be covered only when:
• The procedure for which anesthesia is administered is a covered service under the member’s applicable Benefit Agreement; and

• Consultations rendered by an anesthesiologist for care, other than normal or uncomplicated care, may be eligible for coverage if separately identifiable services were rendered. Substantiating documentation is required for medical review of medical necessity.

Non-Covered Services

Services not covered under the terms of the member’s applicable Benefit Agreement include, but are not limited to, the following:

• Standby anesthesia – Blue Cross does not cover physicians “standing by” in anticipation of needing general anesthesia;
• Anesthesia administered by the operating physician or surgical resident;
• Anesthesia by hypnosis or acupuncture; and/or
• Anesthesia for cosmetic surgery.


Administration of Anesthesia by Operating Physician

No additional payment will be made to an operating physician for anesthesia services rendered during the course of performing a surgical procedure. Under the global guidelines, payment made to a surgeon includes payment for anesthesia administered by the operating surgeon.


Consultations

Anesthesia consultation is part of the global procedure when performed on the day of or before the procedure and is not separately billable. However, there are some circumstances when a consultation is payable:

• Anesthesiologist consults with the patient for management of chronic intractable pain; and

• Anesthesiologist performs the consultation, but no anesthesia procedure is performed. For example, time is spent in discussion with a patient, but the patient was not induced due to complications.

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