Modifiers

CPT modifier 78 and 79 – Usage Guidelines

by Niels
Modifier 79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Modifier 78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period Anesthesia, CCI Editing, Global Days, Multiple Procedure Reduction, Rebundling The physician may ... Read More

BILLING Guide for CRNA Anesthesia services with example

by Niels
Certified Registered Nurse Anesthetists (CRNA) Services  Neighborhood will require all CRNA(s) to become individually credentialed Effective 10/1/2014 Neighborhood will begin reimbursing CRNA services at a percentage of anesthesia allowable. CRNA must be credentialed on the date of service in order to receive reimbursement for the service and all claims must be billed using the CRNA’s ... Read More

Anesthesiologist and CRNA required modifiers

by Niels
Required Modifiers Required Modifiers for  Anesthesiologist    Description     Reimbursement AA Anesthesia services personally performed by anesthesiologist 100 percent of allowable amount AD Medical supervision by a physician, more than four concurrent anesthesia procedures Max 3 base units + time units) effective 10/1/2014 date of service QK Medical direction of two, three or four ... Read More

Anesthesia Billing Guidelines Reminder and Reference

by Niels
The following is a reminder of the billing guidelines for anesthesia services for  UnitedHealthcare Community Plan:  Anesthesia Services – General or monitored anesthesia management services must be submitted with a CPT anesthesia code 00100-01999, except 01953 and 01996. Refer to the Anesthesia Management Codes in the Anesthesia Policy for all applicable codes.  Time ... Read More

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 incorrect modifier usage

by Niels
Anesthesia Modifiers *not an all-inclusive list.  Modifiers must be billed with anesthesia procedure codes to indicate whether the procedure was personally performed, medically directed or medically supervised. Service will deny:  · When billed without appropriate modifier for provider’s specialty · When modifier is not billed in the appropriate modifier position. · When billed with invalid ... 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

Medical Direction and Medical supervision difference

by Niels
Billing for Medical Direction When an anesthesiologist medically directs the services of a CRNA or AA, it is recommended that two separate claims should be submitted using the same CPT code and the same amount of time on each claim with the appropriate modifiers. In unusual circumstances, such as complicated trauma case, it may be ... Read More

Additional Anesthesia Modifiers 22, 23, 53

by Niels
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 ... Read More

Anesthesia Modifiers – Primary and Secondary, Tertiary

by Niels
Modifiers are two-digit indicators that are used with a procedure code to add specific meaning to a service provided. Every anesthesia administrative code billed to Florida Blue must include a modifier. More than one modifier can be submitted per detail line; however, the Florida Blue claims system will adjudicate the claim based only on the ... Read More