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.

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.)

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 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.

Very rare COMPLICATIONS and SIDE EFFECTS of anesthesia services

COMPLICATIONS and SIDE EFFECTS 


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.

Uncommon complication and side effects of anesthesia

COMPLICATIONS and SIDE EFFECTS 

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.