Anesthesia basics

Procedure code 99100, 99116, 99135, 99140 – Billing tips

by Niels
Anesthesia services are provided under difficult circumstances which may affect the condition of the patient, or present unusual operative conditions and / or risk factors. Codes and Definitions 99100 Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure) 99116 Anesthesia ... Read More

Anesthesia incorrect modifier usage

by Niels
Anesthesia Modifiers *not an all-inclusive list.  Modifiers must be billed with anesthesia procedure codes to indicate whether the procedure was personally performed, medically directed or medically supervised. Service will deny:  · When billed without appropriate modifier for provider’s specialty · When modifier is not billed in the appropriate modifier position. · When billed with invalid ... Read More

Anesthesia billing Which form to use

by Niels
A. GENERAL BILLING INFORMATION  Electronic (EDI) HIPPA 5010 compliant 837P format claim submission – Submit total time in minutes in the appropriate field Paper claim submission  – Submit claim using the most current CMS-1500 form.  – Submit total minutes in the unit field. – Submit actual start and stop time (ex. 12:00 to 13:00 or ... Read More

CPT code 01952, 01996

by Niels
Anesthesia for Burns CPT code 01952 is the primary code for billing Anesthesia for Second and Third Degree Burn Excision or Debridement With or Without Skin Grafting. The add-on CPT code 01953 is not considered an anesthesia management service and should not be reported with time. CPT code 01953 may be reported with units of ... Read More

When to use Modifier 59, 73, 74 IN Anesthesia billng?

by Niels
59 Distinct Procedural Service — Services with modifier 59 may be subject to review of medical records. Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, ... Read More

billing anesthesia time units – calculation for personally performed and Medical direction

by Niels
Anesthesia Payment & Billing Information Time and Points Eligible Anesthesia Procedures Defined Blue Cross and Blue Shield of Texas has determined that certain anesthesia procedures will be reimbursed on time and points methodology. Procedures  that  are   not  included  on  the   Anesthesia  Time  &  Points Eligible List will not be reimbursed using time and ... Read More

Payment at the Medically Directed Rate

by Niels
The Part B Contractor determines payment for the physician’s medical direction service furnished on or after January 1, 1998, on the basis of 50 percent of the allowance for the service performed by the physician alone. Medical direction occurs if the physician medically directs qualified individuals in two, three, or four concurrent cases and the ... Read More

Payment at Personally Performed Rate

by Niels
The Part B Contractor must determine the fee schedule payment, recognizing the base unit for the anesthesia code and one time unit per 15 minutes of anesthesia time if: • The physician personally performed the entire anesthesia service alone; • The physician is involved with one anesthesia case with a resident, the physician is a ... Read More

Regional Anesthesia CPT code 01967, 01968 and 01969

by Niels
Topical anesthesia, local, local infiltration and/or metacarpal/digital block, is included in the basic allowance of the surgical procedure performed. No additional reimbursement is provided. • Nerve Blocks -A nerve block involves the injection of a peripheral nerve into or around a given site. If the anesthesiologist administers the injection or block postoperatively in an area ... Read More

Anesthesia During Delivery CPT codes 01967, 99140,

by Niels
Labor Epidurals Anesthesia for labor epidurals are time-based services and should be billed as total minutes. CPT code 01967: Neuraxial Labor Analgesia/Anesthesia for Planned Vaginal Delivery This includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor.)  Code may be reported as a single anesthesia service. ... Read More