Month: July 2010

Anesthesia billing services

by Niels
ANESTHESIA SERVICES Anesthesia is the administration of a drug or gas to induce partial or complete loss of consciousness. Services involving administration of anesthesia should be reported by the use of the Current Procedural Terminology (CPT) anesthesia five-digit procedure code plus modifier codes. Surgery codes are not appropriate unless the anesthesiologist or Certified Registered Nurse ... Read More

Test injection of opioid medication – cpt 62318,62319

by Niels
The test injection of opioid medication (usually morphine) may be billed using one of the following CPT-4 codes: CPT-4 Code    Definition 62318    Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other ... Read More

CPT 62350, 62368, 62362, 62367, 62369 -Reservoir/Pump Implantation

by Niels
Hospitalization Prior authorization is required for hospitalization for the implantable pump procedure.  Catheter implantation, pump/reservoir implantation, removal of pump/reservoir, and electronic analysis of the programmable, implanted pump may be reimbursable with the following codes and appropriate modifiers. CPT-4 Code    Definition Catheter Implantation   62350     Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, ... Read More

Postoperative pain control – CPT 62310,64415,64449

by Niels
Postoperative Pain Control Procedures When provided principally for postoperative pain control, peripheral nerve injections and neuraxial (spinal, epidural) injections can be separately reported on the day of surgery using the appropriate CPT procedure with modifier -59 (Distinct Procedural Service) and 1 unit of service. Examples of such procedures include: 62310-62319     Epidural or subarchnoid injections 64415-64416     ... Read More

Monitored Anesthesia Care billing problem

by Niels
Monitored Anesthesia Care I am having trouble getting claims for MAC paid. What could be the problem? First of all, each state has a LMRP for MAC (Monitored Anesthesia Care). Within these policies there are anesthesia codes for which no other documentation is necessary to support the necessity of MAC (column A codes). Column B ... Read More

External Infusion Pumps – CPT E0779,E0780

by Niels
External Infusion Pumps  HCPCS Code    Definition E0779    Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater E0780    Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours     Note:    Code E0779 will require prior authorization if the billed amount exceeds $100. Prior authorization is required for the implanted infusion pump or reservoir, billed ... Read More

Epidural Opioid Administration

by Niels
Epidural Opioid Administration The intermittent or continuous administration of epidural opioids to treat severe chronic intractable pain of malignant or non-malignant origin is a Medi-Cal benefit, subject to prior authorization.  An implantable infusion pump may be reimbursed when used to administer opioid drugs intrathecally or epidurally in patients with severe chronic intractable pain when the ... Read More

Dental Anesthesia services

by Niels
Dental – General Payment Policies All dental procedures are considered to be outpatient procedures. These procedures are not compensable on an inpatient basis unless there is medical justification which is documented in the patient’s medical record. Provider types 27 – Dentist and 31 – Physician are the only provider types eligible to receive payment for ... Read More

Emergency Anesthesia Modifier – ZB, cpt Q5102, Q9981

by Niels
Emergency Anesthesia Modifier:  Healthy Patient Modifier -ZB may be used to bill for anesthesia services during an emergency procedure on an otherwise healthy or medically stable and uncompromised patient.  Examples of the appropriate use of modifier -ZB are an otherwise healthy adult patient who presents with acute appendicitis, a pediatric patient who presents with a ... Read More

Billing Multiple anesthesia procedure tips

by Niels
Multiple Anesthesia ProceduresPayment may be made under the fee schedule for anesthesia services associated with multiple surgical procedures or multiple bilateral procedures. Payment is based on the base unit of the anesthesia procedure with the highest base unit value and the total time units based on the multiple procedures with the exception of the new ... Read More