Anesthesia services include:
• All customary preoperative and postoperative visits,
• Local anesthesia during surgery,
• The anesthesia care during the procedure,
• The administration of any fluids deemed necessary by the attending
physician, and any usual monitory procedures
Interpretation of non-invasive monitoring to include EKG, temperature, blood
pressure, pulse, breathing, electroencephalogram and other neurological
monitoring, Monitoring of left ventricular or valve function via transesophageal
echocardiogram, Maintenance of open airway and ventilatory measurements and monitoring,
Oximetry, capnography and mass spectrometry.
Monitoring all fluids used during cold cardioplegia through non-invasive
means. Additional claims for such services should not be submitted.
Placement of lines such as arterial catheterizations and insertion and
placement of pulmonary artery catheters (e.g., Swan-Ganz) for monitoring will
no longer be included in the global anesthesia reimbursement when billed
with other procedures but will be allowed to be billed using the same
guidelines outlined in this chapter under “Special Situations for Anesthesia”.
The time of placement of invasive monitors and who placed them should be
documented in the medical record. Verification of anesthesia time units may
be subject to post-payment audits. Billing for anesthesia time while placing
invasive monitors is not allowed unless the patient required general
anesthesia for placement.
The time anesthesia starts is at the beginning of induction via the injection or
inhalation of an anesthetic drug or gas and ends at the time the recipient is
transferred to the recovery room or post anesthesia care unit (PACU).
Induction is defined as the time interval between the initial injection or
inhalation of an anesthetic drug or gas until the optimum level of anesthesia is
reached. The recipient must be prepared by the anesthesiologist prior to
induction and must be assessed by the anesthesiologist immediately after the
surgical procedure. Up to 15 minutes are allowed for the preparation of
anesthesia, and up to 15 minutes are allowed after the operation (for transfer
of the recipient to the receiving room, recovery room, or PACU). It is
inappropriate to bill for anesthesia time while the patient is receiving blood
products or antibiotics in the holding area or waiting in a holding area, or
waiting in the operating room more than 15 minutes prior to induction.
Local anesthesia is usually administered by the attending surgeon and is
considered to be part of the surgical procedure being performed. Additional
claims for local anesthesia by the surgeon should not be filed. Any local
anesthesia administered by an attending obstetrician during delivery (i.e.,
pudendal block or paracervical block) is considered part of the obstetrical
coverage. Additional claims for local anesthesia administered by an attending
obstetrician during delivery should not be filed.
When regional anesthesia (i.e., nerve block) is administered by the attending
physician during a procedure, the physician’s fee for administration of the
anesthesia is billed at one-half the established rate for a comparable service
when performed by an anesthesiologist. When regional anesthesia is
administered by the attending obstetrician during delivery (i.e., saddle block or
continuous caudal), the obstetrician’s fee for administration of the anesthesia
will be billed at one-half the established rate for a comparable service
performed by an anesthesiologist. When regional anesthesia is administered
by an anesthesiologist during delivery or other procedure, the
anesthesiologist’s fee will be covered and should be billed separately.
When an epidural is performed as part of maternity labor/delivery by a
resident, modifiers AA and GC must be billed along with the procedure code
to identify the service is administered under the direction of a physician (AA),
and performed by the resident (GC). When the epidural is performed by a
physician in the absence of a resident, use modifier AA only.
When a medical procedure is a non-covered service under the Alabama
Medicaid Program, the anesthesia for that procedure is also considered to be
a non-covered service.
A primary anesthesia procedure is included in the procedure code range of
00100-01997 as noted in the Relative Value Guide.
Medical record documentation should clearly support and reflect physician
services. Post-payment reviews may be performed.