Anesthesiologist Present but not Administering Anesthesia
CPT-4 procedure codes indicating consultation (99241 – 99275) or detention time (99360) may be used, depending on the service actually rendered. For example, an anesthesiologist might be required to attend a Computerized Tomography scan on a child in the event that anesthesia may be necessary.
If anesthesia is not needed, and therefore the anesthesiologist cannot bill for any other service during this time, detention time may be properly billed. The reason for detention or the nature of the consultation must be entered in the Remarks area/Reserved For Local Use field (Box 19) of the claim or on an attachment.
General Anesthesia Services Guidelines: Medical Necessity
General anesthesia services for procedures not ordinarily requiring anesthesia, or usually requiring only local infiltration, digital block or topical anesthesia, may be billed if medically necessary using the appropriate anesthesia modifiers.
Medical, Radiological, Surgical and Pathological Procedures
Documentation of the medical necessity is required in the Remarks area/Reserved For Local Use field (Box 19) of the claim.
Pelvic Examination Under Anesthesia
Pelvic examination under anesthesia is by definition an independent procedure. However, when it is carried out as an integral part of a total service, it does not warrant a separate charge.
Therefore, a pelvic examination under anesthesia performed in conjunction with an induced abortion is not separately reimbursable under any circumstances. All claims submitted for a pelvic examination performed under anesthesia in combination with an induced abortion for the same patient on the same date of service will be denied.
