Thursday, October 13, 2016

General Billing Guidelines for Anesthesia



Anesthesia billed by an anesthesia practitioner should be billed on the CMS 1500 or 837 P with the
appropriate 5-digit CPT code 00100 - 01995 or 01999 in effect for the date the services were rendered with the appropriate payment modifier.

There are four anesthesia categories as determined by CMS that affect payment of anesthesia services based on the provider rendering the services:

1. Personally Performed – The physician (MD) performs the service alone.

2. Medically Directed – The anesthesiologist is an active participant in the 1, 2, 3, or 4 concurrent cases. Meets the seven steps of medical direction.

o Performs a pre-anesthetic examination and evaluation;

o Prescribes the anesthesia plan;

o Personally participates in the most demanding procedures in the anesthesia plan, including induction and emergence;

o Ensures that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist;

o Monitors the course of anesthesia administration at frequent intervals;

o Remains physically present and available for immediate diagnosis and treatment of emergencies; and

o Provides indicated post-anesthesia care.

3. Medically Supervised – Not completing all steps required for medical direction above, performs a task that prohibits the anesthesiologist from medically directing or is involved in
more than four cases.

4. Teaching – Anesthesiologist is training physician residents in up to two concurrent cases,
or the training of a resident in one case while medically directing another case. In the second
scenario both cases would be billed separately with the right modifiers.

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