Month: June 2010

Normal, Uncomplicated Anesthesia Modifiers – P1, ZE,ZA

by Niels
All anesthesia claims require a modifier.  Failure to use the applicable modifier will result in the claim being returned to the provider for correction.      Modifier P1 must be billed with the appropriate five-digit CPT-4 anesthesia code to identify a normal, uncomplicated anesthesia provided by a physician.     Modifier ZE must be billed with the ... Read More

How to bill when Anesthesiologist Present but not Administering Anesthesia

by Niels
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 ... Read More

Billing Multiple Anesthesia Modifiers

by Niels
When two or more modifiers are necessary to identify the anesthesia services, use modifier ZG with the appropriate five-digit CPT-4 anesthesia code and explain the applicable modifiers in the Remarks field (Box 80)/Reserved for Local Use field (Box 19) of the claim or as an attachment.  Surgical and Obstetrical Anesthesia Operating surgeons and obstetricians providing ... Read More

Start, Stop and Total Anesthesia Time

by Niels
Anesthesia Medical Start, Stop and Total Anesthesia Time Claims billing for more than 40 units of time (10 hours) require that an anesthesia report be attached to the claim.  The anesthesia report must include anesthesia start, stop and total times. CPT-4 Code 01967 Billing Requirements: For CPT-4 code 01967 (neuraxial labor analgesia/anesthesia for planned vaginal ... Read More

Obstetrical Anesthesia Documentation

by Niels
Obstetrical Anesthesia Documentation Providers billing codes 01958, 01960 – 01963, 01965, 01966, 01968 or 01969 for general anesthesia must document “start-stop” and total times on an attached anesthesia report only if the claim is for more than 40 units of time (10 hours).  Providers billing these codes for regional or both general and regional anesthesia ... Read More

Anesthesia referral requirment

by Niels
Prior Authorization and Referral Requirements Anesthesiology procedure codes generally do not require prior authorization. When filing claims for recipients enrolled in the Patient 1st Program, Patient 1st Billing Manual to determine whether your services require a referral from the Primary Medical Provider (PMP). NOTE : Consults performed in the inpatient hospital setting do not require ... Read More

Patient Controlled Analgesia and Intractable Pain and Epidural Catheters

by Niels
Patient Controlled Analgesia Patient controlled analgesia (PCA) services are reimbursable when they are administered by an anesthesiologist and are performed for the control of postoperative pain. A separately identifiable physician-recipient encounter should be reflected in the medical record documentation. PCA pumps are usually administered through an intravenous (IV) line or the PCA pump is connected ... Read More

How to bill anesthesia

by Niels
Medi-Cal has not adopted the “qualifying circumstances” codes (99100 – 99140).  Claims submitted with these codes will be denied or returned to the provider for correction. Billing Anesthesia Services Anesthesia services (CPT-4 codes 00100 – 01999) are reimbursed when medically necessary.  To bill for anesthesia services, use the five-digit CPT-4 code applicable to the procedure ... Read More

Anesthesia consultation

by Niels
Consultations A consultation for anesthesia performed on the day of or days before a procedure is considered part of the global procedure and is not a separately reimbursable item. There are two exceptions to the above as outlined below. — A recipient with chronic intractable pain receives a consult from an anesthesiologist for the chronic ... Read More

Special Situations for Anesthesia

by Niels
Special Situations for Anesthesia If two procedures of special unit value are billed, the first procedure will be paid and the second one will deny because the subsequent procedure is included in the primary anesthesia charge. If two procedures are billed with different unit values, the procedure with the greatest unit value will pay and ... Read More