Month: April 2011

Base unit reduction in payment – anesthesia billing

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

payment rules for anesthesia billing

by Niels
Payment Rules The fee schedule allowance for anesthesia services is based on a calculation that includes the anesthesia base units assigned to each anesthesia code, the anesthesia time involved, and appropriate area conversion factor. The following formulas are used to determine payment: • Participating Physician not Medically Directing (Modifier AA) (Base Units + Time Units) ... Read More

PAYMENT AND REIMBURSEMENT for anesthesia billing

by Niels
PAYMENT AND REIMBURSEMENT Reimbursement Methodology for Anesthesia Services IHCP pricing calculation for anesthesia CPT codes 00100 through 01999 is as follows: Base Units + Time Units + Additional Units for age (if applicable) + Additional Unit for emergency or other qualifying circumstances (if applicable) + Additional Units for physical status modifiers (as applicable) × Anesthesia ... Read More

Teaching Anesthesiologist service – GC modifier

by Niels
Anesthesia Services and Teaching Anesthesiologist If 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 ... Read More

anesthesia billing – some specific points

by Niels
Some specific points that you should be aware of Anesthesia:  CPT coding guidelines for conscious sedation codes instruct practices not to report Codes 99143 to 99145 in conjunction with the codes listed in CPT Appendix G. NHIC will follow the National Correct Coding Initiative, which added edits in April 2006 that bundled CPT codes ... Read More

Pain management cpt codes 62310, 62319, 64415 – 64449

by Niels
Pain Management – Anesthesia Pain Management Consultation Evaluation and management services for postoperative pain control on the day of surgery are considered part of the usual anesthetic services and are not separately reportable. When medically necessary and requested by the attending physician, hospital visits or consultative services are reportable by the anesthesiologist during the postoperative ... Read More

Pain management cpt codes 62310, 62319, 64415 – 64449

by Niels
Pain Management – Anesthesia Pain Management Consultation Evaluation and management services for postoperative pain control on the day of surgery are considered part of the usual anesthetic services and are not separately reportable. When medically necessary and requested by the attending physician, hospital visits or consultative services are reportable by the anesthesiologist during the postoperative ... Read More