Guidelines For Additional Anesthesia Modifiers 22, 23, 53

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…

Services That Are Included In Anesthesia CPT & HCPCS Codes

Services That Are Included In Anesthesia CPT & HCPCS Codes

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…

Certified Registered Nurse Anesthetist Billing Explained

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…

Pre & Post Anesthetic Services And Eligible Providers

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…

What Is Conscious Sedation & Deep Sedation?

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…

What is Qualifying Circumstances?

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….

How Is Payment Calculated For Anesthesia Services?

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…