Wednesday, January 4, 2017

CPT code 00170 - Anesthesia intraoral procedures

Use CPT code 00170 to bill general anesthesia

The Health Insurance Portability and Accountability Act of 1996 mandates that all professional anesthesia services performed on or after Sept. 1, 2002, be reported with CPT-4 anesthesia procedure codes (range *00100-*01999) and national modifiers.

The correct code to report general anesthesia for dental services under the medical program is:

Procedure Code Explanation

00170 Anesthesia for intraoral procedures, including biopsy; not otherwise specified

The medical criteria for the procedure are:

• Children under age four (i.e., through the end of their third year) are approved based on age alone.

• Older patients require a total of six or more teeth extractions, restorations or other procedures performed in two or more quadrants of the mouth, and one of the following:

 – High-risk medical condition that does not permit the  procedure to be performed safely under local anesthesia

 – Infection that does not allow the use of local anesthesia

 – Extensive orofacial and/or dental trauma for which  treatment under local anesthesia would be ineffective  or compromised


Billing Guide

00126, 00170, 01961  - Certified Registered Nurses Anesthetist (CRNA) during tympanotomy, intraoral procedures, or cesarean deliveries: When modifiers QK or QY are used on claims with procedure codes 00126, 00170, or 01961, the services will be reimbursed at 60% of the West Virginia state Medicaid physician fee schedule.

00126, 00170, 00840, 00851, or 01961,- Certified Registered Nurses Anesthetist (CRNA) during tympanotomy, intraoral procedures, lower abdominal surgery, tubal ligation, or cesarean deliveries: When modifier QX is used on claims with procedure codes 00126, 00170, 00840, 00851, or 01961, the services will be reimbursed at 40% of the West Virginia state Medicaid physician fee schedule.

CRNA Services and Modifier Combinations

Modifiers QZ and U1 must be submitted when a CRNA has personally performed the anesthesia services, is not medically directed by the anesthesiologist, and is directed by the surgeon. Modifiers QX and U2 must be submitted by a CRNA who provided services under the medical direction of an anesthesiologist.

Monitored Anesthesia Care

Anesthesiologists or CRNAs may use modifier QS to report monitored anesthesia care.

The QS modifier is an informational modifier, and must be billed with any combination of pricing modifiers for reimbursement.

30.2.4.4 Dental General Anesthesia Procedure code 00170 with modifier U3 should be used when billing for the appropriate reimbursement of dental general anesthesia.

00170 Anesthesia for intraoral procedures, including biopsy; not otherwise specified

General Modifiers Can use with CPT code 00170

The following anesthesia modifiers must be used for anesthesia services: - AA Anesthesia services personally performed by the anesthesiologist. The modifier “AA” may be used if a teaching anesthesiologist is continuously involved in one procedure with one resident or with one student certified registered nurse anesthetist. The teaching anesthesiologist must document in the medical records that he or she was present during all critical portions of the procedure including induction and emergence.

- AD Medical supervision by a physician: more than four concurrent anesthesia procedures;
- QK Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals;
- QX CRNA with medical direction by a physician or anesthesia assistant with medical direction by an anesthesiologist;
- QY Medical direction of one CRNA by an anesthesiologist; and
- QZ CRNA without medical direction by physician.

Note: Anesthesiologist assistants may use the modifier “QX” for services provided under the medical direction of an anesthesiologist if they are employed by a physician or in an independent practice. An anesthesiologist may use the “QY” modifier if he/she provides medical direction to an anesthesiologist assistant.

When it is medically necessary to provide general anesthesia services for extensive restorative dental procedures or for a covered oral surgery procedure for which there is not a surgical code, the anesthesia services must use code 00170 modified by the appropriate anesthesia modifier.

For the reimbursement of anesthesia services the provider must use the anesthesia code that best describes the anesthesia procedure performed modified by the appropriate anesthesia modifier, and report the total anesthesia time in minutes.

Surgical CPT codes that include the administration of anesthesia in the description of that CPT code will only be reimbursed when an anesthesia CPT code in the range 00100-01999 is also coded on the claim. Certain CPT codes will not be reimbursed by CareSource because it is not considered to be a surgery or incident to another surgery.

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