Tuesday, August 16, 2016

BILLING Guide CPT code 00300


Anesthesia for all procedures on the integumentary system,muscles and nerves of head, neck and posterior trunt, not otherwise specified.

Anesthesia for lesion removal is usually performed by the surgeon, If because of the size of the lesion, age or mental status of the patient, or if other conditions are present, the medical necessity of an anethesiologist may be supported. Include any appropriate Icd code necessary or attach report. The appropriate modifier indicating the type of procider as well as the type of service being rendered should be appended tot he procedure code. Modifiers indicating the physical status of the patient should also be appened when required by the third party payer. Medicare does not recognize physical status modifiers.

Monitored Anesthesia Care (MAC) 

CPT code 00300 ANES-INTEG SYST MUSC&NERV HEAD NECK TRUNK;NOS

MAC provided by qualified anesthesia personnel may be reimbursed for these procedures only when one or more of the following conditions are met:

1. It qualifies for use of HCPCS modifier QS:

MAC is appropriate for:

    Combative patients
    Patients with low pain thresholds or who experience severe pain
    Situations where the surgeon anticipates the possible intra-operative expansion of a procedure
    Any condition in a Medicare eligible pediatric patient less than 12 years of age
    The patient has a physical status grade of P3 or higher noted in the medical record
    This modifier may only be submitted with anesthesia procedure codes (i.e., CPT codes 00100-01999)
    Submit HCPCS modifier QS to indicate that the anesthesia service performed as monitored anesthesia care
    This modifier is informational only. You must report actual anesthesia time on the claim
    Submit the HCPCS modifier indicating that the service was personally performed or involved medical direction or medical supervision first, and submit HCPCS modifier QS second


2. It qualifies for use of HCPCS modifier G8 because the procedure being performed is for access to the central venous circulation (CPT code 00532); or is deep, complex, complicated or markedly invasive, and performed on an area of the body that is very sensitive.  These areas include the face (CPT codes 00100 and 00160), neck (CPT code 00300), breast (CPT code 00400), or male genitalia (CPT code 00920).

    Submit the HCPCS modifier indicating that the service was personally performed or involved medical direction or medical supervision first, and submit HCPCS modifier G8 second



3. It qualifies for use of HCPCS modifier G9 because the patient has or had a severe cardiopulmonary condition and MAC is appropriate to prevent intra-operative catastrophe.

    Submit the HCPCS modifier indicating that the service was personally performed or involved medical direction or medical supervision first, and submit HCPCS modifier G9 second

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