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….
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…
Special Situations for Anesthesia If two procedures are billed with different unit values are billed, the first procedure will be paid and the second one will deny because the subsequent procedure is included in the primary anesthesia charge. The anesthetic agent for nerve blocks (CPT codes 64400-64530) is included in the reimbursement fee for the…
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…
Anesthesiology Administration of anesthesia is a covered service when administered by or directed by a duly licensed physician for a medical procedure that is covered by Medicaid. National Provider Identifier, Type, and Specialty A provider who contracts with Alabama Medicaid as an anesthesiologist, CRNA, or AA provider is added to the Medicaid systems with the…
PaymentThe allowed amount is determined based on the anesthesia procedure that has the highest base unit value. Base UnitsDo 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 induction to the…
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…
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 of…
Claim FilingEffective 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 render…
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…
