Month: July 2010

Billing concurrent Medically directed procedures

by Niels
Concurrent Medically Directed Procedures Concurrency is defined with regard to the maximum number of procedures that the physician is medically directing within the context of a single procedure and whether the other procedures overlap each other. Concurrency is not dependent on each of the cases involving a Medicare patient. For example, if an anesthesiologist directs ... Read More

Anesthesiologist billing process

by Niels
Anesthesia Services and Teaching AnesthesiologistIf a teaching anesthesiologist is involved in a single procedure with one resident, the anesthesia services will be paid at the personally performed rate. The teaching physician must document in the medical records that he or she was present during all critical (or key) portions of the procedure. The teaching physician’s ... Read More

Anesthesia type – Minimal sedation , Monitored anesthesia care, Deep sedation

by Niels
Types of Anesthesia First review the ASA’s CONTINUUM OF DEPTH OF SEDATION, DEFINITION OF GENERAL ANESTHESIA ANDLEVELS OF SEDATION/ANALGESIA. This document put out by the ASA is an excellent document for reference when deciphering the different levels of sedation. Minimal Sedation Here the patient responds normally to verbal commands. As the cognitive function and coordination ... Read More

Anesthesia CPT with description

by Niels
00450 5 Anesthesia for procedures on clavicle and scapula; not otherwise specified 00452 6 Anesthesia for procedures on clavicle and scapula; radical surgery 00454 3 Anesthesia for procedures on clavicle and scapula; biopsy of clavicle 00470 6 Anesthesia for partial rib resection; not otherwise specified 00472 10 Anesthesia for partial rib resection; thoracoplasty (any type) ... Read More

Anesthesia billing – Supplies and Drugs Modifiers – ZM, ZN

by Niels
Supplies and Drugs Modifiers Medi-Cal providers must bill with the following modifiers for supplies and drugs used in performing surgical procedures (CPT-4 codes 10000 – 69999): Modifier    Definition     ZM –   Supplies and drugs used in this surgical procedure with other than general anesthesia or no anesthesia.   ZN  –   Supplies and drugs ... Read More

Medical anesthesia billing policy

by Niels
ASA Physical Status Class 3 For a patient with severe systemic disease, ASA Physical Status Class 3 (for example, severe essential hypertension or severe chronic obstructive pulmonary disease), use modifier -P3. ASA Physical Status Class 4 Non-Emergency For a patient with severe systemic disease that is a constant threat to life, ASA Physical Status Class ... Read More

General Anesthesia Reimbursement Limitations – Medical insurance

by Niels
Duplicate Billing Not Allowed Medi-Cal policy prohibits payment for duplicate services and/or billings.  The second and subsequent claims for anesthesia services billed for the same date of service, the same recipient and the same procedure submitted by the same or different providers will be denied with RAD code 328, “Another procedure with an anesthesia modifier ... Read More

Anesthesia Start Time – When Does it Start?

by Niels
Anesthesia Start Time – When Does it Start? Anesthesia time starts when the anesthesiologist begins to prepare the patient for anesthesia care in the operating suite or equivalent area. Time ends when the anesthesiologist is no longer in personal attendance and the patient may be safely placed under post-operative supervision Medicare requires the actual time ... Read More

Anesthesia Modifiers Chart

by Niels
Anesthesia Modifiers Chart The chart below lists the ASA ranking of patient physical status and the modifiers and added unit values associated with the rankings.  It also shows three special circumstance modifiers and their added units of value. Patient Physical Status HCPCS Modifier Added Units of Value 1. Normal, healthy patient or patient with mild ... Read More

Referring provider and POS

by Niels
Referring Provider Information Effective July 1, 2004, anesthesia providers must submit the UPIN number of the referring surgeon/physician on the claim. If you file hard copy, the UPIN number should be populated in block 1 7a of the CMS 1500 claim form. For those who file electronically, you should submit the referring surgeon/physician’s UPIN number. ... Read More