Month: July 2010

Anesthesia CRNA SERVICES AND BILLING FOR qualified anesthetists and CRNA

by Niels
CRNA Services Medicare provides payment to CRNAs and AAs. CRNAs and AAs may bill directly for their services or have payment made to an employer or an entity under which they havea contract. This could be a hospital, physician, group practice or Ambulatory Surgical Center (ASC). Reimbursement for CRNA services is made only on an ... Read More

Anesthesia billing when teaching physician involved with example

by Niels
Teaching Physician Medicare pays an unreduced fee schedule payment if a teaching anesthesiologist is involved in a single procedure with one resident. The teaching physician must document in the medical records that he was present during all critical or key portions of the procedure. The teaching physician’s physical presence during only the preoperative or postoperative ... Read More

Concurrent Medically Directed Anesthesia Procedures payment

by Niels
Payment Conditions for Anesthesiology Services Definition of Concurrent Medically Directed Anesthesia Procedures Concurrency is defined with regard to the maximum number of procedures the anesthesiologist is medically directing within the context of a single procedure and whether these other procedures overlap each other. Concurrency is not dependent on each of the cases involving a Medicare ... Read More

anesthesial billing payment for Medical Supervision, Group practice, billing documentation

by Niels
Anesthesia Payment  Medical Supervision If an anesthesiologist is medically directing more than four CRNAs, the Medicare regulations indicate that the service must be billed as medically supervised as opposed to medically directed anesthesia services. The anesthesiologist should bill with the AD modifier and the CRNA should bill with the QX modifier. The Medicare payment to ... Read More

Anesthesia payment when wo Anesthesiologists or Two CRNAs

by Niels
Unusual Circumstances – CRNA and Anesthesiologist In unusual circumstances, when it is medically necessary for both the CRNA and the anesthesiologist to be completely and fully involved during a procedure, full payment for the services of each provider is allowed. Each provider must submit documentation to support payment of the full fee. The physician would ... Read More

Anesthesia payment when personally performed services

by Niels
Payment Conditions for Anesthesiology Services Personally Performed Services  The physician personally performed the entire anesthesia service alone.  The physician is involved with one anesthesia case with a resident and the physician is a teaching physician as defined in the IOM, Pub.100-04, Chapter 12, Section 100 at http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf.  The physician is involved in ... Read More

Anesthesia modifier – where to report in CMS 1500 and electronic loop

by Niels
Informational (No additional payment for informational modifiers)Modifier Description G9 Monitored Anesthesia Care (MAC) for patient who has history of severe cardiopulmonary condition P1 A normal healthy patient P2 A patient with mild systemic disease P3 A patient with severe systemic disease P4 A patient with severe systemic disease that is a constant threat to life ... Read More

Anesthesia billing payment – Medical direction CRNA

by Niels
Payment Conditions for Anesthesiology Services Medical Direction For a single anesthesia case involving both a physician medical direction service and the service of the medically directed CRNA, the payment amount for each service may be no greater than 50 percent of the allowance. The total payment for both may not exceed the amount that would ... Read More

Anesthesia modifier with example – Modifier description

by Niels
Modifiers Modifiers are two-digit indicators used to modify payment of a procedure code, assist in determining appropriate coverage or otherwise identify the detail on the claim. Every anesthesia procedure billed to Medicare must include one of the following anesthesia modifiers: AA, QY, QK, AD, QX or QZ. The other modifiers listed below may be used ... Read More

Anesthesia CPT CODES catagory

by Niels
Descriptor  Code Range Head CPT CODE -00100–00222 Neck CPT CODE 00300–00352 Thorax (chest wall and shoulder girdle) 00400–00474 Intrathoracic 00500–00580 Spine and Spinal Cord 00600–00670 Upper Abdomen 00700–00797 Lower Abdomen 00800–00882 Perineum 00902–00952 Pelvis (except hip) 01112–01190 Upper Leg (except knee) 01200–01274 Knee and Popliteal Area 01320–01444 Lower Leg (below knee, includes ankle and foot) ... Read More