Month: August 2010

MAC and medical necessary documents with modifier using

by Niels
Appropriate documentation must be available to reflect pre- and post-anesthetic evaluations and intra-operative monitoring. The MAC service rendered must be reasonable, appropriate and medically necessary.  The anesthesia procedures listed in the LCD are examples of those that are usually provided by the attending surgeon and are included in the global fee and are not ... Read More

Anesthesia payment when multiple anesthesia services and using with modifier

by Niels
MULTIPLE ANESTHESIA SERVICES Same Operative Session Payment can be made for anesthesia services associated with multiple surgical procedures. The payment is based on the anesthesia procedure with the highest base unit value. The time units will equal the actual anesthesia time for both procedures. Example:Provider Date of Service Procedure Time Base Units ABC 01/01/2009 00700 ... Read More

Anesthesia payment reimbursement examples

by Niels
REIMBURSEMENT EXAMPLES (Time Units + Base Units) x Conversion Factor = Allowance Texas Example 1 (This is an example only. Providers should check their current anesthesia conversion factors for correct fee amounts.) Rev. 01/2010 24 Reimbursement Examples Code: 00830 Time: 120 minutes Locality: Rest of state (participating physician) Time: 120/15 = 8 units Code: 00830 ... Read More

Anesthesia new cpt codes – 99143,99144, 99148,99150

by Niels
2009 CPT Code Descriptions  99143©: Moderate sedation services (other than those services described by codes 00100–01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; younger ... Read More

Anesthesia Blood Gas Monitoring and Pre-Anesthetic Exams/Cancelled Surgery

by Niels
Blood Gas Monitoring Blood gas monitoring performed as part of an anesthesiologist’s service is considered to be an integral part of the anesthesia service and is not reimbursed separately. Bundled Services 99100© Special anesthesia service 99116© Anesthesia with hypothermia 99135© Special anesthesia procedure 99140© Emergency anesthesia Separate payment will not be allowed for these services; ... Read More

Anesthesia billing limitation

by Niels
Limitations Based on the CPT Definitions 99143–99145  An independent trained observer whose sole duty is to monitor the patient’s level of consciousness and physiological status must be present throughout the diagnostic or therapeutic service. The anesthesia note must identify this person and his credentials (e.g., RN, NPP, PA).  “Intra-service time starts with the ... Read More

Anesthesia billing conversion factor

by Niels
CONVERSION FACTOR The anesthesia conversion factors for each calendar year are listed by payment locality and are effective for the date the service was provided. The participating physician anesthesia conversion factor is listed first, the non-participating physician anesthesia conversion factor is second, and the non-medically directed conversion factor is listed in the third column. The ... Read More

CPT 90870 , 01967 – Electroconvulsive Therapy – Add-On Codes of Anesthesia

by Niels
Electroconvulsive Therapy (ECT) – 90870 Electroconvulsive Therapy (ECT) is used in the treatment of depression and related disorders and other severe psychiatric conditions. When a psychiatrist administers the anesthesia for the ECT procedure, no separate payment is made for the anesthesia service. Add-On Codes for Anesthesia Anesthesia add-on codes are priced differently than multiple anesthesia ... Read More

How to calculate anesthesia time and reporting CMS 1500 and EDI

by Niels
ANESTHESIA TIME Anesthesia time begins when the anesthesiologist starts to prepare the patient for the procedure. Normally, this service takes place in the operating room, but in some cases, preparation may begin in another location (i.e., holding area). Anesthesia time is a continuous time period from the start of anesthesia to the end of an ... Read More

ANESTHESIA PAYMENT FORMULA

by Niels
The allowance for anesthesia services is based on the following formula: Rev. 01/2010 13 Anesthesia Formula(Time Units + Base Units) X Conversion Factor = Allowance Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time, the anesthesia practitioner can add blocks of ... Read More