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…
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 Florida Blue must include a modifier. More than one modifier can be submitted per detail line; however, the Florida Blue claims system will adjudicate the claim based only on the…
Anesthesia HCPCS/CPT codes include all services integral to the anesthesia procedure such as preparation, monitoring, intra-operative care, and post-operative care until the patient is released by the anesthesiologist to the care of another physician. Which Services Are Included? Examples of integral services include, butare not limited to, the following: Transporting, positioning, prepping, draping of the…
Anesthesia Billing for CRNAs A timely topic if ever there was one! This issue continues to be a source of confusion to physician offices, billers, hospitals, and insurance companies, too. A Certified Registered Nurse Anesthetist (CRNA) is an advanced practice nurse who is an anesthesia specialist and may administer anesthesia independently or under physician “medical…
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…
There are different providers of anesthesia services. Below a list with descriptions of the most common providers. What Is Anesthesiology? Anesthesiology isthe practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery. What Is An Anesthesiologist? An anesthesiologist is a physician who specializes in…
Conscious SedationThe intent of conscious sedation is for the patient to remain conscious and able to communicate during the entire procedure. The patient retains the ability to independently and continuously maintain a patent airway and respond appropriately to physical stimulation and/or verbal command. Conscious sedation includes performance and documentation of pre- and postsedation evaluations of…
Pre-anesthetic Evaluations and Post-operative Visits MHCP uses the CMS list of base values, which were adopted from the relative base values established by the ASA. The base value for anesthesia services includes usual pre-operative and post-operative visits. No separate payment is allowed for the pre-anesthetic evaluation regardless of when it occurs unless the recipient is…
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….
Payment RulesThe 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) x Participating Conversion…
