Billing and coding tips

Anesthesia and Medical/Surgical Service Provided by the Same Physician

by Niels
Anesthesia services range in complexity. The continuum of anesthesia services, from least intense to most intense in complexity is as follows: local or topical anesthesia, moderate (conscious) sedation, regional anesthesia and general anesthesia. Prior to 2006, Medicare did not recognize separate payment if the same physician provided the medical or surgical procedure and the anesthesia ... Read More

two anesthesia procedure billed on same day with different unit

by Niels
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 ... Read More

Anesthesia Services Billing Instructions – How to fill the claim form

by Niels
Policy The following provider types can bill for anesthesia services: �� Physician, M.D., Osteopath (provider type 20) �� Certified RN Practitioner (provider type 24) �� Nurse Anesthetists (provider type 72)  This policy covers base units, reportable anesthesia time and appropriate billing.  Covered Services and Rates Covered services and rates are listed on the Division of ... Read More

NCD for Anesthesia in Cardiac Pacemaker Surgery

by Niels
 Benefit Category Inpatient Hospital Services Outpatient Hospital Services Incident to a Physician’s Service Physicians’ Services Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service. Indications and Limitations of Coverage The use of general or monitored anesthesia during transvenous cardiac pacemaker surgery may be reasonable and ... Read More

Anesthesiologist billing process

by Niels
Anesthesia Services and Teaching AnesthesiologistIf a teaching anesthesiologist is involved in a single procedure with one resident, the anesthesia services will be paid at the personally performed rate. The teaching physician must document in the medical records that he or she was present during all critical (or key) portions of the procedure. The teaching physician’s ... Read More

Billing concurrent Medically directed procedures

by Niels
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 ... Read More

Billing Multiple anesthesia procedure tips

by Niels
Multiple Anesthesia ProceduresPayment may be made under the fee schedule for anesthesia services associated with multiple surgical procedures or multiple bilateral procedures. Payment is based on the base unit of the anesthesia procedure with the highest base unit value and the total time units based on the multiple procedures with the exception of the new ... Read More

EMPIRE MEDICARE’S covered diagnosis for anesthesia

by Niels
 EMPIRE MEDICARE’S POLICY FOR ANESTHESIA AND GASTORINESTINAL ENDOSCOPY ICD-9 CM Diagnosis Codes that Support Medical Necessity It is not enough to link the procedure code to a correct, payable ICD-9-CM diagnosis code. The diagnosis or clinical suspicion must be present for the procedure to be paid. Below are diagnosis codes that support medical necessity. ICD-9 ... Read More

Use of Anesthesia Services for Routine Gastrointestinal Endoscopy

by Niels
Use of Anesthesia Services for Routine Gastrointestinal Endoscopy Key Points: Sedation-related risk factors, the depth of sedation, and the urgency of the endoscopic procedure all play important roles in determining whether the assistance of anesthesia personnel is needed. Sedation related risk factors include significant medical conditions such as extremes of age, severe pulmonary, neurological, cardiac, ... Read More

Insurance Payment rule for Anesthesia Medically supervised rate

by Niels
Payment at Medically Supervised Rate Only three (3) base units per procedure are allowed when the anesthesiologist is involved in rendering more than four (4) procedures concurrently or is performing other services while directing the concurrent procedures. An additional time unit can be recognized if the physician can document he/she was present at induction. Modifier ... Read More