CPT codes

Medical and Surgical Services Rendered in Addition to Anesthesia Procedures

by Niels
ANESTHESIA SERVICES Medical and Surgical Services Rendered in Addition to Anesthesia Procedures Payment may be made under the fee schedule for specific medical and surgical services by the anesthesiologist as long as these services are reasonable and medically necessary or provided other rebundling provisions do not preclude separate payment. These services may be rendered in ... Read More

Anesthesia Group practice billing

by Niels
GROUP PRACTICE If anesthesiologists are in a group practice, one physician member may provide the preanesthesia examination and evaluation while another fulfills the other criteria. Similarly, one physician member of the group may provide post-anesthesia care while another member of the group furnishes the other component parts of the anesthesia service. The medical record must ... Read More

Medical direction anesthesia – personally performed

by Niels
Medical Direction & Temporary Relief CRNAs/AAs providing anesthesia services under the medical direction of an anesthesiologist must have uninterrupted immediate availability of an anesthesiologist at all times. When a medically directing anesthesiologist provides temporary relief to another anesthesia provider, the need for uninterrupted immediate availability may be met by any of the following strategies: • ... Read More

Separately Reimbursable Anesthesia Services

by Niels
Medi-Cal insurance separately reimburses for the following anesthesia services. CPT-4 Code    Definition 36555    Insertion of non-tunneled centrally inserted central venous catheter; under 5 years of age 36556    Age 5 years or older 36568    Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; under 5 years of age 36569        Age 5 ... Read More

Normal, Uncomplicated Anesthesia Modifiers – P1, ZE,ZA

by Niels
All anesthesia claims require a modifier.  Failure to use the applicable modifier will result in the claim being returned to the provider for correction.      Modifier P1 must be billed with the appropriate five-digit CPT-4 anesthesia code to identify a normal, uncomplicated anesthesia provided by a physician.     Modifier ZE must be billed with the ... Read More

How to bill when Anesthesiologist Present but not Administering Anesthesia

by Niels
Anesthesiologist Present but not Administering Anesthesia CPT-4 procedure codes indicating consultation (99241 – 99275) or detention time (99360) may be used, depending on the service actually rendered.  For example, an anesthesiologist might be required to attend a Computerized Tomography scan on a child in the event that anesthesia may be necessary. If anesthesia is not ... Read More

Billing Multiple Anesthesia Modifiers

by Niels
When two or more modifiers are necessary to identify the anesthesia services, use modifier ZG with the appropriate five-digit CPT-4 anesthesia code and explain the applicable modifiers in the Remarks field (Box 80)/Reserved for Local Use field (Box 19) of the claim or as an attachment.  Surgical and Obstetrical Anesthesia Operating surgeons and obstetricians providing ... Read More

Start, Stop and Total Anesthesia Time

by Niels
Anesthesia Medical Start, Stop and Total Anesthesia Time Claims billing for more than 40 units of time (10 hours) require that an anesthesia report be attached to the claim.  The anesthesia report must include anesthesia start, stop and total times. CPT-4 Code 01967 Billing Requirements: For CPT-4 code 01967 (neuraxial labor analgesia/anesthesia for planned vaginal ... Read More

Anesthesia referral requirment

by Niels
Prior Authorization and Referral Requirements Anesthesiology procedure codes generally do not require prior authorization. When filing claims for recipients enrolled in the Patient 1st Program, Patient 1st Billing Manual to determine whether your services require a referral from the Primary Medical Provider (PMP). NOTE : Consults performed in the inpatient hospital setting do not require ... Read More

Obstetrical Anesthesia Documentation

by Niels
Obstetrical Anesthesia Documentation Providers billing codes 01958, 01960 – 01963, 01965, 01966, 01968 or 01969 for general anesthesia must document “start-stop” and total times on an attached anesthesia report only if the claim is for more than 40 units of time (10 hours).  Providers billing these codes for regional or both general and regional anesthesia ... Read More