1. Principles of Medicare coding for anesthesia services involving administration of anesthesia are reported by the use of the anesthesia five-digit CPT procedure codes (00100-01860). These codes specify “Anesthesia for” followed by a general area of surgical intervention. Subsequent CPT codes (01905-01933) are unique to anesthesia for interventional radiology. SeveralCPT codes (01990-01999) describe miscellaneous anesthesia services.
Anesthesia services are provided by or under the supervision of a physician. These services may include, but are not limited to, general or regional anesthesia and monitoring of physiological parameters during local or peripheral block anesthesia with sedation (when medically necessary), or othersupportive services in order to afford the patient anesthesia care deemed optimal by the anesthesiologist during any procedure.
Anesthesia codes describe a general anatomic area or service which usually relates to a number of surgical procedures, often from multiple sections of the CPT Manual. For Medicare purposes, only one anesthesia code is reported unless the anesthesia code is an add-on code. In this case, both the codefor the primary anesthesia service and the anesthesia add-on code are reported according to CPT Manual instructions. It is acceptable to bill the code that accurately describes the anesthesia for the procedure which has the highest basic unit value.
2. Another unique characteristic of anesthesia coding is the reporting of time units for time spent delivering anesthesia. In contrast to some evaluation and management services which can be coded based on time, payment foranesthesia services varies with or increases with increments oftime. In addition to billing a basic unit value for an anesthesia service, the units of service reflecting the time of anesthesia attendance are reported. Anesthesia time involves the continuous actual presence of the anesthesiologist and starts when the anesthesiologist begins to prepare the patient for anesthesia care in the operating room or equivalent area andends when the anesthesiologist is no longer in personal attendance, i.e., when the patient may be safely placed under postoperative supervision. Non-monitored interval time may not be considered for calculation of time units.
Example: A patient who undergoes a cataract extraction may require monitored anesthesia care (see below). This may require administration of a sedative in conjunction with a peri/retrobulbar injection for regional block anesthesia.Subsequently, an interval of 30 minutes or more may transpire during which time the patient does not require monitoring by an anesthesiologist/certified registered nurse anesthetist. After this period, monitoring will commence again for the cataract extraction and ultimately the patient will be released to thesurgeon’s care or to recovery. The time that may be reported would include the time for the monitoring during the block and during the procedure. The interval time and the recovery time are not to be included in the time unit calculation. Also, if unusual services, not bundled into the anesthesia service, arerequired, the time spent delivering these services before anesthesia time begins or after it ends may not be included as reportable anesthesia time.
However, if it is medically necessary for the anesthesiologist/CRNA to be in direct one to one observation, monitoring the patient during the interval time, and not billing any other service, the time can be included.