Anesthesia Question and answer

Modifier question on anethesia claims?

by Niels
Q. What defines medical direction? For each anesthesia procedure, the anesthesiologist must perform all of the following seven services and they must be recorded in the anesthesia record: 1. Perform a pre-anesthetic examination and evaluation; 2. Prescribe the anesthesia plan; 3. Personally participate in the most demanding procedures of the anesthsia plan including, if applicable, ... Read More

Anesthesia and CRNA billing question?

by Niels
Q. Why has Blue Cross made a decision to contract with CRNAs and AAs? Healthcare Reform Provider Non-discrimination PPACA § 1201; PHSA § 2706(a) NON-DISCRIMINATION IN HEALTH CARE requires that group health plans and health insurers shall not discriminate against health care providers acting within the scope of their license or certification under the laws ... 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

BCBS claim filing limit for Anesthesia claims

by Niels
Claim Filing Effective for dates of service on or after January 1, 2014, Blue Cross requires claims for anesthesiologists, CRNAs and AAs to be billed under the name and National Provider Identifier (NPI) of the provider who  actually rendered the service. Blue Cross does not recognize “incident to” billing for anesthesia services. All providers should ... Read More

What is Qualifying Circumstances ?

by Niels
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. ... Read More

modifier AA. AD, QK, QK , QZ How much payment would be reimbursed

by Niels
Modifier Description % of Allowed Charge AA Anesthesia services performed personally by the anesthesiologist 100 percentAD Medical supervision by a physician; more than four concurrent anesthesia procedures. (Three base units + actual time units allowed) 65 percentQK Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals). 65 percentQY Medical direction of ... Read More

Covered and non covered service – would Aneshesia consultation covered seperately ?

by Niels
According to CPT guidelines, the reporting of anesthesia services is appropriate by or under the responsible supervision of a physician. These services may include, but are not limited to, general, regional and supplementation of local anesthesia or other supportive services in order to provide the patient with optimal anesthesia care during any procedure. Covered Services ... Read More

Some basic question on Anesthesia billing ?

by Niels
Payment The allowed amount is determined based on the anesthesia procedure that has the highest base unit value. Base Units Do not submit base units on the claim, they will be included in the calculation of the allowed amount. Anesthesia Time ** Submit the exact number of minutes from the preparation of the patient for ... Read More

CPT codes which are not inclusive in Anesthesia billing

by Niels
CPT® codes describing services that are integral to an anesthesia service include but are not limited to, the following: •  99201-99499 (Evaluation and management) The CPT® book, in its Anesthesia Guidelines, at the start of the Anesthesia section, states, “These services include the usual preoperative and postoperative visits….” In a copy of a lecture presented ... Read More

will peroperative assement inculsive in anesthesia billing?

by Niels
Citations: Preoperative assessment is included in the payment for the anesthesia services, per the National Correct Coding Initiative (NCCI). HCPCS/CPT® codes include all services usually performed as part of the procedure as a standard of medical/surgical practice.  A physician should not separately report these services simply because HCPCS/CPT® codes exist for them. 1. The anesthesia ... Read More