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 three concurrent procedures, two of which involve non-Medicare patients and one Medicare patient, this represents three (3) concurrent cases.
The following example illustrates this concept and guides physicians in determining how many procedures are directed:
Procedures A through E are medically directed procedures involving CRNAs. The starting and ending times for each procedure represent the periods during which anesthesia times are counted.
Procedure A begins at 8:00AM and ends at 8:20AM
Procedure B begins at 8:10AM and ends at 8:45AM
Procedure C begins at 8:30AM and ends at 9:15AM
Procedure D begins at 9:00AM and ends at 12:00 noon
Procedure E begins at 9:10AM and ends at 9:55AM
Procedure Number of Concurrent Medically Directed Procedures Base Unit Reduction Percentage
A 2 10%
B 2 10%
C 3 25%
D 3 25%
E 3 25%
A physician who is concurrently directing the administration of anesthesia to not more than four (4) surgical patients cannot ordinarily be involved in rendering additional services to other patients.
However, addressing an emergency of short duration in the immediate area, administering an epidural or caudal anesthetic to ease labor pain, or periodic, rather than continuous monitoring of an obstetrical patient, does not substantially diminish the scope of control exercised by the physician in directing the administration of anesthesia to the surgical patients. It does not constitute a separate service for the purpose of determining whether the medical direction criteria are met. Further, while directing concurrent anesthesia procedures, a physician may receive patients entering the operating suite for the next surgery, check or discharge patients in the recovery room, or handle scheduling matters without affecting fee schedule payment.
However, if the physician leaves the immediate area of the operating suite for other than short durations or devotes extensive time to an emergency case or is otherwise not available to respond to the immediate needs of the surgical patients, the physician’s services to the surgical patients are supervisory in nature. No fee schedule payment is made.
The examples listed above are not intended to be an exclusive list of allowed situations. It is expected that the medically-directing anesthesiologist is aware of the nature and type of services he or she is medically directing, and is personally responsible for determining whether his supervisory capacity would be diminished if he or she became involved in the performance of a procedure. It is the responsibility of this medically-directing anesthesiologist to provide services consistent with these regulations.
Friday 29 April 2011
Thursday 28 April 2011
payment rules for anesthesia billing
Payment Rules
The fee schedule allowance for anesthesia services is based on a calculation that includes the anesthesia base units assigned to each anesthesia code, the anesthesia time involved, and appropriate area conversion factor. The following formulas are used to determine payment:
• Participating Physician not Medically Directing (Modifier AA)
(Base Units + Time Units) x Participating Conversion Factor = Allowance
• Non-Participating Physician not Medically Directing (Modifier AA)
(Base Units + Time Units) x Non-Participating Conversion Factor=Allowance
• Participating Physician Medically Directing (Modifier QY, QK)
(Base Units + Time Units) x Participating Conversion Factor = Allowance x 50%
• Non-Participating Physician Medically Directing (Modifier QY, QK)
(Base Units + Time Units) x Non-Participating Conversion Factor = Allowance x 50%
• Non-Medically Directed CRNA (Modifier QZ)
(Base Units + Time Units) x Participating Conversion Factor = Allowance
• CRNA Medically Directed (Modifier QX)
(Base Units + Time Units) x Participating Conversion Factor = Allowance x 50%
The fee schedule allowance for anesthesia services is based on a calculation that includes the anesthesia base units assigned to each anesthesia code, the anesthesia time involved, and appropriate area conversion factor. The following formulas are used to determine payment:
• Participating Physician not Medically Directing (Modifier AA)
(Base Units + Time Units) x Participating Conversion Factor = Allowance
• Non-Participating Physician not Medically Directing (Modifier AA)
(Base Units + Time Units) x Non-Participating Conversion Factor=Allowance
• Participating Physician Medically Directing (Modifier QY, QK)
(Base Units + Time Units) x Participating Conversion Factor = Allowance x 50%
• Non-Participating Physician Medically Directing (Modifier QY, QK)
(Base Units + Time Units) x Non-Participating Conversion Factor = Allowance x 50%
• Non-Medically Directed CRNA (Modifier QZ)
(Base Units + Time Units) x Participating Conversion Factor = Allowance
• CRNA Medically Directed (Modifier QX)
(Base Units + Time Units) x Participating Conversion Factor = Allowance x 50%
Tuesday 26 April 2011
PAYMENT AND REIMBURSEMENT for anesthesia billing
PAYMENT AND REIMBURSEMENT
Payment at Personally Performed Rate
The fee schedule payment for a personally performed procedure is based on the full base unit and one time unit per 15 minutes of service if the physician personally performed the entire procedure. Modifier AA is appropriate when services are personally performed.
Payment at Medically Directed Rate
When the physician is medically directing a qualified anesthetist (CRNA, Anesthesiologist Assistant) in a single anesthesia case or a physician is medically directing 2, 3, or 4 concurrent procedures, the payment amount for each is 50% of the allowance otherwise recognized had the service been performed by the physician alone.
These services are to be billed as follows:
1. The physician should bill using modifier QY, medical direction of one CRNA by a physician or QK, medical direction of 2, 3, or 4 concurrent procedures.
2. The CRNA/Anesthesiologist Assistant should bill using modifier QX, CRNA service with medical direction by a physician.
Payment at Non-Medically Directed Rate
In unusual circumstances, when it is medically necessary for both the anesthesiologist and the CRNA/Anesthesiologist Assistant to be completely and fully involved during a procedure, full payment for the services of each provider are allowed. Documentation must be submitted by each provider to support payment of the full fee.
These services are to be billed as follows:
1. The physician should bill using modifier AA, anesthesia services personally performed by anesthesiologist, and modifier 22, with attached supporting documentation.
2. The CRNA/Anesthesiologist Assistant should bill using modifier QZ, CRNA/Anesthesiologist Assistant services; without medical direction by a physician, and modifier 22, with attached supporting documentation.
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 AD is appropriate when services are medically supervised.
Payment at Personally Performed Rate
The fee schedule payment for a personally performed procedure is based on the full base unit and one time unit per 15 minutes of service if the physician personally performed the entire procedure. Modifier AA is appropriate when services are personally performed.
Payment at Medically Directed Rate
When the physician is medically directing a qualified anesthetist (CRNA, Anesthesiologist Assistant) in a single anesthesia case or a physician is medically directing 2, 3, or 4 concurrent procedures, the payment amount for each is 50% of the allowance otherwise recognized had the service been performed by the physician alone.
These services are to be billed as follows:
1. The physician should bill using modifier QY, medical direction of one CRNA by a physician or QK, medical direction of 2, 3, or 4 concurrent procedures.
2. The CRNA/Anesthesiologist Assistant should bill using modifier QX, CRNA service with medical direction by a physician.
Payment at Non-Medically Directed Rate
In unusual circumstances, when it is medically necessary for both the anesthesiologist and the CRNA/Anesthesiologist Assistant to be completely and fully involved during a procedure, full payment for the services of each provider are allowed. Documentation must be submitted by each provider to support payment of the full fee.
These services are to be billed as follows:
1. The physician should bill using modifier AA, anesthesia services personally performed by anesthesiologist, and modifier 22, with attached supporting documentation.
2. The CRNA/Anesthesiologist Assistant should bill using modifier QZ, CRNA/Anesthesiologist Assistant services; without medical direction by a physician, and modifier 22, with attached supporting documentation.
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 AD is appropriate when services are medically supervised.
Monday 25 April 2011
Teaching Anesthesiologist service - GC modifier
Anesthesia Services and Teaching Anesthesiologist
If 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 physical presence during only the preoperative or postoperative visits with the beneficiary is not sufficient to receive Medicare payment. If an anesthesiologist is involved in concurrent procedures with more than one resident or with a resident and a non-physician anesthetist, the anesthesiologist’s services will be paid at the medically directed rate.
Use modifier GC (Teaching Physician Service) to indicate the service has been performed in part by a resident under the direction of a teaching physician. This modifier is added after the anesthesia modifier.
Non-Covered Anesthesia Services
The following anesthesia services are non-covered:
• Stand By
If 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 physical presence during only the preoperative or postoperative visits with the beneficiary is not sufficient to receive Medicare payment. If an anesthesiologist is involved in concurrent procedures with more than one resident or with a resident and a non-physician anesthetist, the anesthesiologist’s services will be paid at the medically directed rate.
Use modifier GC (Teaching Physician Service) to indicate the service has been performed in part by a resident under the direction of a teaching physician. This modifier is added after the anesthesia modifier.
Non-Covered Anesthesia Services
The following anesthesia services are non-covered:
• Stand By
Friday 22 April 2011
anesthesia billing - some specific points
Some specific points that you should be aware of Anesthesia:
CPT coding guidelines for conscious sedation codes instruct practices not to report Codes 99143 to 99145 in conjunction with the codes listed in CPT Appendix G. NHIC will follow the National Correct Coding Initiative, which added edits in April 2006 that bundled CPT codes 99143 and 99144 into the procedures listed in Appendix G (There are no edits for code 99145; it is an add-on-code and it is not paid if the primary code is not paid.)
In the unusual event that a second physician (other than the one performing the diagnostic or therapeutic services) provides moderate sedation in the facility setting for the procedures listed in CPT Appendix G, the second physician can bill 99148 to 99150, but cannot report these codes when the second physician performs these services (on the same day as a medical/surgical service) in the non-facility setting.
If an anesthesiologist or CRNA provides anesthesia for diagnostic or therapeutic nerve blocks or injections, and a different provider performs the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using CPT code 01991. In this case, the service must meet the criteria for monitored anesthesia care. If the anesthesiologist or CRNA provides both the anesthesia service and the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using the conscious sedation code and the injection or block. However, the anesthesia service must meet the requirements for conscious sedation and if a lower level complexity anesthesia service is provided, then the conscious sedation code should not be reported.
There is no CPT code for the performance of local anesthesia, and as such, payment for this service is considered to be part of the payment for the underlying medical or surgical service. Therefore, if the physician performing the medical or surgical procedure also provides a level of anesthesia lower in intensity than moderate or conscious sedation (such as a local or topical anesthesia), then the conscious sedation code should not be reported and the contactor will allow no payment.
When denying claims, as appropriate under this policy, contractors will use the message when the service is bundled into the other service: “Payment is included in another service received on the same day.”
Contractors will adjust claims brought to their attention that were not processed in accordance with the Medicare physician fee schedule data base indicators assigned to the conscious sedation codes. Requests for reopening may be submitted to the Written Inquiries Department in your jurisdiction.
CPT coding guidelines for conscious sedation codes instruct practices not to report Codes 99143 to 99145 in conjunction with the codes listed in CPT Appendix G. NHIC will follow the National Correct Coding Initiative, which added edits in April 2006 that bundled CPT codes 99143 and 99144 into the procedures listed in Appendix G (There are no edits for code 99145; it is an add-on-code and it is not paid if the primary code is not paid.)
In the unusual event that a second physician (other than the one performing the diagnostic or therapeutic services) provides moderate sedation in the facility setting for the procedures listed in CPT Appendix G, the second physician can bill 99148 to 99150, but cannot report these codes when the second physician performs these services (on the same day as a medical/surgical service) in the non-facility setting.
If an anesthesiologist or CRNA provides anesthesia for diagnostic or therapeutic nerve blocks or injections, and a different provider performs the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using CPT code 01991. In this case, the service must meet the criteria for monitored anesthesia care. If the anesthesiologist or CRNA provides both the anesthesia service and the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using the conscious sedation code and the injection or block. However, the anesthesia service must meet the requirements for conscious sedation and if a lower level complexity anesthesia service is provided, then the conscious sedation code should not be reported.
There is no CPT code for the performance of local anesthesia, and as such, payment for this service is considered to be part of the payment for the underlying medical or surgical service. Therefore, if the physician performing the medical or surgical procedure also provides a level of anesthesia lower in intensity than moderate or conscious sedation (such as a local or topical anesthesia), then the conscious sedation code should not be reported and the contactor will allow no payment.
When denying claims, as appropriate under this policy, contractors will use the message when the service is bundled into the other service: “Payment is included in another service received on the same day.”
Contractors will adjust claims brought to their attention that were not processed in accordance with the Medicare physician fee schedule data base indicators assigned to the conscious sedation codes. Requests for reopening may be submitted to the Written Inquiries Department in your jurisdiction.
Monday 18 April 2011
Pain management cpt codes 62310, 62319, 64415 - 64449
Pain Management - Anesthesia
Pain Management Consultation
Evaluation and management services for postoperative pain control on the day of surgery are considered part of the usual anesthetic services and are not separately reportable. When medically necessary and requested by the attending physician, hospital visits or consultative services are reportable by the anesthesiologist during the postoperative period. However, normal postoperative pain management, including management of intravenous patient controlled analgesia, is considered part of the surgical global package and should not be separately reported.
Postoperative Pain Control Procedures
When provided principally for postoperative pain control, peripheral nerve injections and neuraxial (spinal, epidural) injections can be separately reported on the day of surgery using the appropriate CPT procedure with modifier -59 (Distinct Procedural Service) and 1 unit of service. Examples of such procedures include:
62310-62319 Epidural or subarchnoid injections
64415-64416 Brachial plexus injection, single or continuous
64445-64448 Sciatic or femoral injections, single or continuous
64449 Lumbar plexus injections, continuous
These services should not be reported on the day of surgery if they constitute the surgical anesthetic technique.
NOTE: Modifier 59 requires that the medical record substantiate that the procedure or service was a distinct or separate services performed on the same day.
Daily Management of Continuous Pain Control Techniques
Daily hospital management of continuous epidural or subarachnoid drug administration is reported using CPT code 01996 (1 unit of service daily). This code may be reported on the first and subsequent postoperative days as medically necessary.
When continuous block codes 64416, 64446, 64448, or 64449 are reported on the day of surgery, no additional reporting of daily management is permitted during the following ten days (10 day global period). When these injections procedures constitute the main surgical anesthetic and are therefore not separately reported on the day of surgery, subsequent days’ hospital management is reported using the appropriate hospital visit code (99231-99233).
Pain Management Consultation
Evaluation and management services for postoperative pain control on the day of surgery are considered part of the usual anesthetic services and are not separately reportable. When medically necessary and requested by the attending physician, hospital visits or consultative services are reportable by the anesthesiologist during the postoperative period. However, normal postoperative pain management, including management of intravenous patient controlled analgesia, is considered part of the surgical global package and should not be separately reported.
Postoperative Pain Control Procedures
When provided principally for postoperative pain control, peripheral nerve injections and neuraxial (spinal, epidural) injections can be separately reported on the day of surgery using the appropriate CPT procedure with modifier -59 (Distinct Procedural Service) and 1 unit of service. Examples of such procedures include:
62310-62319 Epidural or subarchnoid injections
64415-64416 Brachial plexus injection, single or continuous
64445-64448 Sciatic or femoral injections, single or continuous
64449 Lumbar plexus injections, continuous
These services should not be reported on the day of surgery if they constitute the surgical anesthetic technique.
NOTE: Modifier 59 requires that the medical record substantiate that the procedure or service was a distinct or separate services performed on the same day.
Daily Management of Continuous Pain Control Techniques
Daily hospital management of continuous epidural or subarachnoid drug administration is reported using CPT code 01996 (1 unit of service daily). This code may be reported on the first and subsequent postoperative days as medically necessary.
When continuous block codes 64416, 64446, 64448, or 64449 are reported on the day of surgery, no additional reporting of daily management is permitted during the following ten days (10 day global period). When these injections procedures constitute the main surgical anesthetic and are therefore not separately reported on the day of surgery, subsequent days’ hospital management is reported using the appropriate hospital visit code (99231-99233).
Sunday 20 March 2011
CPT codes which are not inclusive in Anesthesia billing
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 by Dr. James Arens, posted on the ASA website, he discusses the fact that these pre-operative visits are not payable.
“For many years the preoperative visit was considered to be part of the global fee for anesthesia services based upon base units plus time. With the advent of preoperative anesthesia(assessment) clinics, the scope of this service has undergone drastic change. The history and past records review has become much more extensive. The evaluation of the patient and the explanation of the risk and options have also become much more detailed. I have heard surgeons state that they are no longer "capable" of assessing patients to undergo anesthesia. Yet the ability to bill for such services is very limited. The values of a well run preoperative clinic are self-evident. However, the inability to collect for these services rendered has caused several clinics to be closed. The codes (99201-99205) for evaluation and management services are quite simple. However, reimbursement for this valuable service remains problematic.”
Summary:
It would be improper for any group to bill for preoperative anesthesia assessments. The payment for that service is included in the payment for the anesthesia payment itself. Any money collected for these services in the would have to be returned to the payers. In addition, any hospital providing this service would need to review with its attorney the issue of providing financial support to a for-profit entity.
• 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 by Dr. James Arens, posted on the ASA website, he discusses the fact that these pre-operative visits are not payable.
“For many years the preoperative visit was considered to be part of the global fee for anesthesia services based upon base units plus time. With the advent of preoperative anesthesia(assessment) clinics, the scope of this service has undergone drastic change. The history and past records review has become much more extensive. The evaluation of the patient and the explanation of the risk and options have also become much more detailed. I have heard surgeons state that they are no longer "capable" of assessing patients to undergo anesthesia. Yet the ability to bill for such services is very limited. The values of a well run preoperative clinic are self-evident. However, the inability to collect for these services rendered has caused several clinics to be closed. The codes (99201-99205) for evaluation and management services are quite simple. However, reimbursement for this valuable service remains problematic.”
Summary:
It would be improper for any group to bill for preoperative anesthesia assessments. The payment for that service is included in the payment for the anesthesia payment itself. Any money collected for these services in the would have to be returned to the payers. In addition, any hospital providing this service would need to review with its attorney the issue of providing financial support to a for-profit entity.
Tuesday 15 March 2011
will peroperative assement inculsive in anesthesia billing?
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 care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and post- anesthesia recovery care.
Preoperative evaluation includes a sufficient history and physical examination so that the risk of adverse reactions can be minimized, alternative approaches to anesthesia planned, and all questions answered.
2. Anesthesia services include, but are not limited to, preoperative evaluation of the patient, administration of anesthetic, other medications, blood, and fluids, monitoring of physiological parameters, and other supportive services.
3. It is standard medical practice for an anesthesia practitioner to perform a patient examination and evaluation prior to surgery. This is considered part of the anesthesia service and is included in the base unit of the anesthesia code.
The evaluation and examination are not reported in the anesthesia time. If surgery is canceled, subsequent to the preoperative evaluation, payment may be allowed to the anesthesiologist for an evaluation and management service and the appropriate E&M code (usually a consultation code) may be reported. (A non-medically directed CRNA may also report an E&M code under these circumstances if permitted by state law.)
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 care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and post- anesthesia recovery care.
Preoperative evaluation includes a sufficient history and physical examination so that the risk of adverse reactions can be minimized, alternative approaches to anesthesia planned, and all questions answered.
2. Anesthesia services include, but are not limited to, preoperative evaluation of the patient, administration of anesthetic, other medications, blood, and fluids, monitoring of physiological parameters, and other supportive services.
3. It is standard medical practice for an anesthesia practitioner to perform a patient examination and evaluation prior to surgery. This is considered part of the anesthesia service and is included in the base unit of the anesthesia code.
The evaluation and examination are not reported in the anesthesia time. If surgery is canceled, subsequent to the preoperative evaluation, payment may be allowed to the anesthesiologist for an evaluation and management service and the appropriate E&M code (usually a consultation code) may be reported. (A non-medically directed CRNA may also report an E&M code under these circumstances if permitted by state law.)
Friday 11 March 2011
Anesthesia cpt code procedure qualifiying factor and description units.
Procedure Codes and Modifiers
Anesthesia providers are required to utilize the appropriate anesthesia code
identified in the current Relative Value Guide published by the American
Society of Anesthesiologists. Time in attendance should be billed by listing
total minutes
HP will calculate total units by dividing the total minutes (reported in block
24G) by 15, rounding up to the next whole number, and adding the time units
to the auto-loaded base unit values. The base unit values are derived from
the ASARVG for CPT-4 anesthesia codes.
of anesthesia time in block 24G of the CMS-1500 claim form.
Type of service “7” should be used for billing anesthesia codes (00100-
01997). The (837) Institutional electronic claim and the paper claim have
been modified to accept up to four Procedure Code Modifiers. Effective
October 1, 2004 to bill for code 90784, bill the first line item with the code and
one unit. Bill the second line item with code 90784 with modifier 76 (repeat
procedure) and 3 units.
The number of qualifying factor units is multiplied by the price allowed for
anesthesia services. For more information regarding qualifying factors, see
the next section of this manual.
Qualifying Factors
Beginning June 14, 2002, qualifying factors will be reimbursable. Qualifying
factors allow for anesthesia services provided under complicated situations
depending on irregular factors (ex: abnormal risk factors, significant operative
conditions). The qualifying procedures would be reported in conjunction with
the anesthesia procedure code on a separate line item using 1 unit of service.
The qualifying procedure codes are indicated below.
Procedure Code Description Units
99100 Anesthesia for recipient with farthest ages, over
seventy and under one year 1
99116 Complication of anesthesia by utilization of total
body hypothermia 1
99135 Complication of anesthesia by utilization of
controlled hypotension 1
99140 Complication of anesthesia by emergency
conditions 1
Anesthesia providers are required to utilize the appropriate anesthesia code
identified in the current Relative Value Guide published by the American
Society of Anesthesiologists. Time in attendance should be billed by listing
total minutes
HP will calculate total units by dividing the total minutes (reported in block
24G) by 15, rounding up to the next whole number, and adding the time units
to the auto-loaded base unit values. The base unit values are derived from
the ASARVG for CPT-4 anesthesia codes.
of anesthesia time in block 24G of the CMS-1500 claim form.
Type of service “7” should be used for billing anesthesia codes (00100-
01997). The (837) Institutional electronic claim and the paper claim have
been modified to accept up to four Procedure Code Modifiers. Effective
October 1, 2004 to bill for code 90784, bill the first line item with the code and
one unit. Bill the second line item with code 90784 with modifier 76 (repeat
procedure) and 3 units.
The number of qualifying factor units is multiplied by the price allowed for
anesthesia services. For more information regarding qualifying factors, see
the next section of this manual.
Qualifying Factors
Beginning June 14, 2002, qualifying factors will be reimbursable. Qualifying
factors allow for anesthesia services provided under complicated situations
depending on irregular factors (ex: abnormal risk factors, significant operative
conditions). The qualifying procedures would be reported in conjunction with
the anesthesia procedure code on a separate line item using 1 unit of service.
The qualifying procedure codes are indicated below.
Procedure Code Description Units
99100 Anesthesia for recipient with farthest ages, over
seventy and under one year 1
99116 Complication of anesthesia by utilization of total
body hypothermia 1
99135 Complication of anesthesia by utilization of
controlled hypotension 1
99140 Complication of anesthesia by emergency
conditions 1
Wednesday 9 March 2011
Anesthesia claim filing limit and copayment for anesthesia services
Time Limit for Filing Claims
Medicaid requires all claims for Anesthesiologists, CRNAs and AAs to be filed
within one year of the date of service. Refer to Section 5.1.4, Filing Limits, for
more information regarding timely filing limits and exceptions.
Diagnosis Codes
The International Classification of Diseases - 9th Revision - Clinical
Modification (ICD-9-CM) manual lists required diagnosis codes. These
manuals may be obtained by contacting the American Medical Association,
P.O. Box 10950, Chicago, IL 60610.
NOTE:
ICD-9 diagnosis codes must be listed to the highest number of digits possible
(3, 4, or 5 digits). Do not use decimal points in the diagnosis code field
Cost Sharing (Copayment)
Copayment amount does not apply to services provided by Anesthesiologists,
Certified Registered Nurse Anesthetists or Anesthesiology Assistants.
Medicaid requires all claims for Anesthesiologists, CRNAs and AAs to be filed
within one year of the date of service. Refer to Section 5.1.4, Filing Limits, for
more information regarding timely filing limits and exceptions.
Diagnosis Codes
The International Classification of Diseases - 9th Revision - Clinical
Modification (ICD-9-CM) manual lists required diagnosis codes. These
manuals may be obtained by contacting the American Medical Association,
P.O. Box 10950, Chicago, IL 60610.
NOTE:
ICD-9 diagnosis codes must be listed to the highest number of digits possible
(3, 4, or 5 digits). Do not use decimal points in the diagnosis code field
Cost Sharing (Copayment)
Copayment amount does not apply to services provided by Anesthesiologists,
Certified Registered Nurse Anesthetists or Anesthesiology Assistants.
Saturday 5 March 2011
Very rare COMPLICATIONS and SIDE EFFECTS of anesthesia services
COMPLICATIONS and SIDE EFFECTS
Very rare (1/10,000 - 1/200,000)
Very rare (1/10,000 - 1/200,000)
- DAMAGE TO THE EYES: Anaesthetists take great care to protect your eyes. Your eyelids are held closed with adhesive tape, which is removed before you wake up. However, sterilizing fluids could leak past the tapes or you could brush your eyes as you wake up after the tapes have been removed. These could cause damage to the surface of your eye, which is usually temporary and responds to drops.
- SERIOUS ALLERGY TO DRUGS: Allergic reactions will be noticed and treated very quickly. Very rarely, these reactions lead to death even in healthy people. Your anaesthetist will want to know about any allergies in yourself or your family. It has been estimated that the incidence of serious allergy to drugs in the operating room is about 1/10,000-13,000.
- NERVE DAMAGE: Nerve damage (paralysis or numbness) may be due to damage by the needle when performing a regional block, or it can be caused by pressure on a nerve during an operation. Most nerve damage is temporary and recovers within two to three months.
- DEATH: Deaths caused by anaesthesia are very rare, and are usually caused by a combination of four or five complications arising together. There are probably about 4-5 deaths for every million anaesthetics.
- EQUIPMENT FAILURE: Vital equipment that could fail includes The anaesthetic gas supply or the ventilator. Monitors are now used which give an immediate warning of problems, and these failures rarely have serious effects.
Tuesday 1 March 2011
Uncommon complication and side effects of anesthesia
COMPLICATIONS and SIDE EFFECTS
Uncommon (1/1,000)
Uncommon (1/1,000)
- CHEST INFECTION: A chest infection is more likely to happen to people who smoke, and may lead to breathing difficulties. This is why it is very important to give up smoking for as long as possible before your anaesthetic.
- BLADDER PROBLEMS: After certain types of operation and regional anaesthesia (particularly with a spinal or epidural), men may find it difficult to pass urine, and women tend to leak. To prevent problems, a urinary catheter may be inserted at a suitable time.
- MUSCLE PAINS: These sometimes happen if you have received a drug called suxamethonium. This is a muscle relaxant which is given for emergency surgery when your stomach may not be empty.
- SLOW BREATHING (DEPRESSED RESPIRATION): Some pain-relieving drugs can cause slow breathing or drowsiness after the surgery. If muscle relaxants are still having an effect (have not been fully reversed), the breathing muscles may be weak. These effects can treated with other drugs.
- DAMAGE TO TEETH, LIPS, OR TONGUE: Damage can be caused to your teeth by clenching them as you recover from The anaesthetic. If your anaesthetist finds it difficult to get the breathing tube in the right place, your teeth may also be damaged. It will be more likely if you have limited mouth opening (for example, if you have arthritis of the jaw), a small jaw or a stiff neck.
- AN EXISTING MEDICAL CONDITION GETTING WORSE: Your anaesthetist will always make sure that you are as fit as possible before your surgery. However, if you have had a heart attack or stroke, it is possible that it may happen again – as it might even without the surgery. Other conditions such as diabetes or high blood pressure will also need to be closely monitored and treated.
- AWARENESS: Your risk of becoming conscious during your operation will depend on your general health and the type of operation you are having. For example, if you are very ill, the anaesthetist may use a combination of muscle relaxants and a lighter general anaesthetic to reduce the risks to you. However, the risk of your being aware of what is going on is increased. Monitors are used During the operation to record how much anaesthetic is in your body and how your body is responding to it. These normally allow your anaesthetist to prevent your anaesthetic from becoming too light. If you think you may have been conscious during your operation, your anaesthetist should be told about it as soon as possible. He or she will want to know, to help both you and future patients.
Friday 25 February 2011
Genral COMPLICATIONS and SIDE EFFECTS
COMPLICATIONS and SIDE EFFECTS
Very common (1/10 - 1/100)
Very common (1/10 - 1/100)
- FEELING SEEK AND VOMITIMG AFTER SURGERY: Some operations and anaesthetic and pain-relieving drugs are more likely to cause sickness (nausea) than others. Sickness can be treated with anti-vomiting drugs (anti-emetics), but it may last from a few hours to several days.
- SORE THROAT: If you have had a tube in your airway to help you breathe, it may give you a sore throat. The discomfort or pain lasts from a few hours to days and can be treated with pain-relieving lozenges.
- DIZZINESS, BLURRED VISION: Your anaesthetic or loss of fluids may lower your blood pressure and make you feel faint. Fluids or drugs (or both) will be given into your drip to treat this.
- SHIVERING: This may be due to you getting cold during the surgery, to some drugs, or to stress. You can be warmed very efficiently using a hot-air blanket.
- HEADACHE: This may be due to the effects of The anaesthetic, to the surgery, to lack of fluids, or to anxiety. More severe headaches may occur after a spinal or epidural anaesthetic. The headache usually gets better in a few hours and can be treated with pain relievers. If it lasts a long time, it may need special treatment.
- ITCHING: This is a side effect of opiates (such as morphine) but can also happen as an allergic reaction (for example, to drugs, sterilising fluids or stitches (sutures). If you have itchiness, it can be treated with other drugs.
- ACHES, PAINS AND BACKACHE: During your operation you may lie in the same position on a firm operating table for a long time. Great care is taken to position you, but some people still feel uncomfortable afterwards.
- PAIN DURING INJECTION OF DRUGS: Drugs used may cause some pain or discomfort when they are injected.
- BRUISING AND SORENESS: This may be caused around injection and drip sites by a thin vein bursting, movement of a nearby joint, or infection. It normally settles without treatment, but if the area becomes uncomfortable, the position of the drip can be changed.
- CONFUSION OR MEMORY LOSS: This is common among older people who have had an operation under general anaesthetic. It may be due to several causes. It is usually temporary, but may last a few days or weeks.
Sunday 20 February 2011
HOw to recover from anesthesia services
Recovering From Anesthesia
Leaving the recovery area
When your normal body functions have returned, you either will be transferred to another location in the hospital to complete your recovery or allowed to go home.In many cases minor surgical procedures are done on an outpatient basis. This means you will go home the same day. Before you are discharged from an outpatient clinic, you should be alert and able to understand and remember instructions. You will also want to make sure you have regained muscle control and coordination enough to walk safely, take fluids without vomiting, and take oral pain medicines safely. Depending on your medical history, your surgeon may also want you to be able to urinate before you are discharged.
When you are discharged, make sure you have:
- Reliable transportation to your home and for return to the hospital if complications develop. Do not plan to drive yourself home.
- A competent adult caregiver who can be with you for 24 hours after discharge.
- Access to a telephone so you can call for assistance if complications develop.
- Access to a pharmacy so you can get your prescriptions.
Thursday 17 February 2011
Recovering and after anesthesia treatment
Recovering From Anesthesia
Recovery from anesthesia occurs as the effects of the anesthetic medicines wear off and your body functions begin to return. Immediately after surgery, you will be taken to a post-anesthesia care unit (PACU), often called the recovery room. There, nurses will care for and observe you. A nurse will check your vital signs and bandages and ask about your pain level.How quickly you recover from anesthesia depends on the type of anesthesia you received, your response to the anesthesia, and whether you received other medicines that may prolong your recovery. As you begin to awaken from general anesthesia, you may experience some confusion, disorientation, or difficulty thinking clearly. This is normal. It may take some time before the effects of the anesthesia are completely gone.
Your age and general health also may affect how quickly you recover. Younger people usually recover more quickly from the effects of anesthesia than older people. People with certain medical conditions may have difficulty clearing anesthetics from the body, which can delay recovery.
After anesthesia
Some of the effects of anesthesia may persist for many hours after the procedure. For example, you may have some numbness or reduced sensation in the part of your body that was anesthetized until the anesthetic wears off completely. Your muscle control and coordination may also be affected for many hours following your procedure. Other effects may include:- Pain. As the anesthesia wears off, you can expect to feel some pain and discomfort from your surgery. In some cases, additional doses of local or regional anesthesia are given to block pain during initial recovery. Pain following surgery can cause restlessness as well as increased heart rate and blood pressure. If you experience pain during your recovery, tell the nurse who is watching you so that your pain can be relieved.
- Nausea and vomiting. You may have a dry mouth and/or nausea. Nausea and vomiting are common after any type of anesthesia. It is a common cause of an unplanned overnight hospital stay and delayed discharge. Vomiting may be a serious problem if it causes pain and stress or affects surgical incisions. Nausea and vomiting are more likely with general anesthesia and lengthy procedures, such as surgery on the abdomen, the middle ear, or the eyes. In most cases, nausea after anesthesia does not last long and can be treated with medicines called antiemetics.
- Low body temperature (hypothermia). You may feel cold and shiver when you are waking up. A mild drop in body temperature is common during general anesthesia, because the anesthetic reduces your body's heat production and affects the way your body regulates its temperature. Special measures are often taken during surgery to keep a person’s body temperature from dropping too much (hypothermia).
Monday 14 February 2011
Know about spinal anesthesia
Spinal anesthesia
Spinal anesthesia involves the injection of a medication into the canal next to the spinal cord. It is used to numb the body below the chest, usually before a surgical procedure.The area where the needle will be inserted is first numbed with a local anesthetic, then the needle is guided into the spinal canal and the anesthetic is injected. The person may not be able to move his or her legs until the anesthetic wears off.
Saturday 12 February 2011
anesthetic medicines risks
Risks from reactions to anesthetic medicines
Some anesthetic medicines may cause allergic or other abnormal reactions in some people, but these are rare. If you suspect you may have such a problem, you should tell both your surgeon and anesthesia specialist well before your surgery. Testing will then be arranged as needed.A rare, potentially fatal condition called malignant hyperthermia (MH) may be triggered by some anesthetics. The anesthetics most commonly associated with malignant hyperthermia include the potent inhalation anesthetics and the muscle relaxant succinylcholine. For more information, see the listing for the Malignant Hyperthermia Association of the United States (MHAUS) in the Other Places to Get Help section of this topic.
Thursday 10 February 2011
Define anesthesia team
ANESTHESIA TEAMS
An anesthesia team is defined as one directing anesthesiologist and one CRNA providing services to
a member. The payment split between the anesthesiologist and medically directed CRNA equals 100
percent of the payment level for an individually performing anesthesiologist with the anesthesiologist
receiving 60 percent and the medically directed CRNA 40 percent.
Only one provider or anesthesia team will be paid for epidural anesthesia.
An anesthesia team is defined as one directing anesthesiologist and one CRNA providing services to
a member. The payment split between the anesthesiologist and medically directed CRNA equals 100
percent of the payment level for an individually performing anesthesiologist with the anesthesiologist
receiving 60 percent and the medically directed CRNA 40 percent.
Only one provider or anesthesia team will be paid for epidural anesthesia.
Sunday 6 February 2011
Know about Intractable Pain and Epidural Catheters
Intractable Pain and Epidural Catheters
Some forms of conventional therapy such as oral medication, physical
therapy, or a TENS unit may not relieve recipients with intractable pain.
Placement of an epidural catheter may be allowed when medically necessary
for recipients with intractable pain. Reimbursement for daily management is
allowed when it is medically necessary and is a separately identifiable
physician-recipient encounter is clearly documented in the medical record by
the anesthesiologist. Placement of an epidural catheter and daily
management of an epidural catheter is not reimbursable on the same date of
service.
Some forms of conventional therapy such as oral medication, physical
therapy, or a TENS unit may not relieve recipients with intractable pain.
Placement of an epidural catheter may be allowed when medically necessary
for recipients with intractable pain. Reimbursement for daily management is
allowed when it is medically necessary and is a separately identifiable
physician-recipient encounter is clearly documented in the medical record by
the anesthesiologist. Placement of an epidural catheter and daily
management of an epidural catheter is not reimbursable on the same date of
service.
Monday 17 January 2011
complication and side effects of general anesthesia
Complications from general anesthesia
Serious side effects of general anesthesia are uncommon in people who are otherwise healthy. But because general anesthesia affects the whole body, it is more likely to cause side effects than local or regional anesthesia. Fortunately, most side effects of general anesthesia are minor and can be easily managed.General anesthesia suppresses the normal throat reflexes that prevent aspiration, such as swallowing, coughing, or gagging. Aspiration occurs when an object or liquid is inhaled into the respiratory tract (the windpipe or the lungs). To help prevent aspiration, an endotracheal (ET) tube may be inserted during general anesthesia. When an ET tube is in place, the lungs are protected so stomach contents cannot enter the lungs. Aspiration during anesthesia and surgery is very uncommon. To reduce this risk, people are usually instructed not to eat or drink anything for a certain number of hours before anesthesia so that the stomach is empty. Anesthesia specialists use many safety measures to minimize the risk of aspiration.
Insertion or removal of airways may cause respiratory problems such as coughing; gagging; or muscle spasms in the voice box, or larynx (laryngospasm), or in the bronchial tubes in the lungs (bronchospasm). Insertion of airways also may cause an increase in blood pressure (hypertension) and heart rate (tachycardia). Other complications may include damage to teeth and lips, swelling in the larynx, sore throat, and hoarseness caused by injury or irritation of the larynx.
Other serious risks of general anesthesia include changes in blood pressure or heart rate or rhythm, heart attack, or stroke. Death or serious illness or injury due solely to anesthesia is rare and is usually also related to complications from the surgery. Death occurs in about 1 out of 200,000 healthy people who get anesthesia.
Some people who are going to have general anesthesia express concern that they will not be completely unconscious but will "wake up" and have some awareness during the surgical procedure. But awareness during general anesthesia is very rare. Anesthesia specialists devote careful attention and use many methods to prevent this.
Tuesday 4 January 2011
Complications from local and regional anesthesia
Complications from local anesthesia
When used properly, local anesthetics are safe and have few major side effects. But in high doses, local anesthetics can have toxic effects caused by being absorbed through the bloodstream into the rest of the body (systemic toxicity). This may significantly affect your breathing, heartbeat, blood pressure, and other body functions. Because of these potential toxic effects, equipment for emergency care must be immediately available when local anesthetics are used.Complications from regional anesthesia
For regional anesthesia, an anesthetic is injected close to a nerve, a bundle of nerves, or the spinal cord. In rare cases, nerve damage can cause persistent numbness, weakness, or pain.Regional anesthesia (regional nerve blocks, epidural and spinal anesthesia) also carries the risk of systemic toxicity if the anesthetic is absorbed through the bloodstream into the body. Other complications include heart or lung problems, and infection, swelling, or bruising (hematoma) at the injection site.
Spinal anesthesia medicine is injected into the fluid that surrounds the spinal cord (cerebrospinal fluid). The most common complication of spinal anesthesia is a headache caused by leaking of this fluid. It is more common in younger people. A spinal headache may be treated quickly with a blood patch to prevent further complications. A blood patch involves injecting a small amount of the person's own blood into the area where the leak is most likely occurring to seal the hole and to increase pressure in the spinal canal and relieve the pull on the membranes surrounding the canal.
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