Specific Instruction for Anesthesia Billing – Utah Medicaid
A. Anesthesia providers billing ASA procedure codes electronically are reminded to report anesthesia time in minutes. Enter total time in minutes in the “minutes” field. Please verify that the correct MJ qualifier is being output by your software program. To report units, the qualifier is UN. UHIN Standard #1 requires that anesthesia time be reported in minutes instead of units.
Anesthesia providers billing ASA procedure codes on paper claim forms are reminded to report the anesthesia time in minutes. Enter the number of minutes in Box 24G of the CMS-1500 form by putting an “M” before the number for the minutes. Example: M531 in Box 24G.
If an ASA procedure is submitted without minutes or the correct MJ qualifier, Medicaid will pay one time unit, i.e., 12 minutes or less. Postoperative pain management using code 01996 is an exception to the instructions listed above. Units will be attached to this code but no time payment is made. Submit claims with a UN qualifier indicating units, a single unit per date of service, and a “P” modifier (physical status). There will be no additional payment related to the physical status of the patient. The code describes a daily pain management service and code 01996 is reimbursed beginning the day following surgery. There is only one exception to this policy, refer to the Limitations.
Anesthesia providers billing for dental services should use code 41899 with the appropriate “P” modifier and the actual anesthesia time in minutes. Prior Authorization is required under certain conditions. Refer to the Dental or Oral Surgeon Provider Manuals for criteria. Follow the instructions outlined above using the MJ qualifier
Obstetrical anesthesia is an exception to Medicaid’s policy concerning multiple procedures performed during a single anesthetic administration. Providers billing for anesthesia related to delivery are reminded that for neuraxial analgesia/anesthesia for planned vaginal delivery which becomes a Cesarean delivery, the code 01967 should be used to begin the procedure. When C-Section is imminent, discontinue use of 01967 and change to code 01968. Continue on with straight time as for general surgery, reporting minutes for each anesthesia code. Procedure codes 01968 and 01969 are add-on codes which must always be submitted with the primary code 01967. These codes will not be reimbursed when billed as the only procedure code.
B. Diagnosis: A specific diagnosis code must be used. The code 00840 used for intraabdominal procedures may deny without diagnoses clearly indicating the procedure is not for sterilization.