ANESTHESIA REIMBURSEMENT METHODOLOGY Code Description Comments 01960 Anesthesia for vaginal delivery only Bill when no neuraxial/anesthesia is involved with vaginal delivery; not reimbursed with 01967 01961 Anesthesia for Cesarean delivery only Use to report anesthesia services…
Intra-operative monitoring by an anesthesiologist, physician, or other qualified individual under the medical direction of the anesthesiologist, of the patient’s vital physiological signs in anticipation of the need for administration of general anesthesia or of the development of adverse physiological patient reaction to the surgical procedure. MAC is eligible for coverage when performed by the…
Anesthesia Modifiers Modifiers are two-digit indicators that are used with a procedure code to add specific meaning to a service provided. Every anesthesia administrative code billed to BCBSF must include a modifier. More than one modifier can be submitted per detail line; however, the BCBSF claims system will adjudicate the claim based only on the…
The following modifiers should be used as secondary or tertiary modifiers only and not as the primary modifier. These modifiers are intended to provide additional information specific to the services provided; there will be no additional reimbursement made for these modifiers. Modifier Description 22 Increased Procedural Service — Per CPT Appendix A modifiers: When the…
Intravenous medicines for anesthesia Intravenous (IV) anesthetic medicines are given into a vein. They can be given quickly and are rapidly absorbed into the blood. IV anesthetics are used to relieve pain (analgesia), to relax (sedate), to induce sleepiness (hypnosis) or forgetfulness (amnesia), or to make you unconscious for general anesthesia. Most IV anesthetics cannot…
Post-Operative Pain Management and Epidural Catheters Surgeons routinely provide necessary post-operative pain managementservices and are reimbursed for these services through the global surgeryfee. The surgeon should manage post-operative pain except underextraordinary circumstances. Procedures involving major intra-abdominal,vascular and orthopedic, and intrathoracic procedures will be covered forpost-operative pain management by an anesthesiologist when medicallyindicated. Postoperative pain management…
Not reimbursed separately but should be billed when appropriate 99100 – Anesthesia for Patient of Extreme Age, Under 1 Year and Over 7099116 – Anesthesia Complicated By Utilization of Total Body Hypothermia99135 – Anesthesia Complicated By Utilization of Controlled Hypotension99140 – Anesthesia Complicated By Emergency Conditions Non-reimbursable Services Services billed by anesthesia assistantsServices provided by…
Services are provided by a qualified anesthesia provider to a surgical patient while in a state of analgesia or anesthesia so that surgical intervention can be undertaken. Anesthesia services consist of the administration of an anesthetic agent, typically by injection or inhalation, causing partial or complete loss of sensation, with or without loss of consciousness….
Modifier 79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Modifier 78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period Anesthesia, CCI Editing, Global Days, Multiple Procedure Reduction, Rebundling The physician may…
Qualifying circumstances are those factors such as extreme age, extraordinary condition of the patient, and unusual risk factors which may affect the anesthesia services. These procedures are considered add-on codes and would not be reported alone, but as additional procedures qualifying an anesthesia procedure or service. These procedures must be filed with the appropriate modifier….
