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Anesthesia (anest)

By Marjorie Peterson,2014-12-03 16:57
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Anesthesia (anest)

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    Anesthesia 1

This section is to assist providers in completing claims for anesthesia services. Medi-Cal has not adopted

    the “qualifying circumstances” codes (99100 – 99140). Claims submitted with these codes will be denied or returned to the provider for correction. For additional help, refer to the Anesthesia Billing Examples

    section of this manual.

Billing Anesthesia Services Anesthesia services (CPT-4 codes 00100 01999) are reimbursed

    when medically necessary. To bill for anesthesia services, use the

    five-digit CPT-4 code applicable to the procedure with the appropriate

    modifier. For anesthesia modifiers, see Modifiers: Approved List in

    this manual and the anesthesia modifiers charts in this section.

    Billing in 15-Minute Increments To bill anesthesia time units, enter the number of 15-minute of Anesthesia Time increments of anesthesia time in the Service Units/Days or Units box

    on the claim form, using the same billing line as the procedure code.

    Each 15-minute increment equals one time unit. Increments of time

    less than five minutes are not reimbursable except when the total

    anesthesia time being billed is less than five minutes. For more

    information, see the “Total Anesthesia Time Unit: Less Than Five

    Minutes” section.

    Total Anesthesia Time Unit: The last anesthesia time increment rendered may be rounded up to a More Than Five Minutes whole unit if it equals or exceeds five minutes. If the last anesthesia

    time increment provided is less than five minutes, it may not be billed

    as an additional anesthesia time unit.

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Time Unit Billing Examples Time unit examples:

    ; For 49 minutes of anesthesia time actually spent with the

    patient, enter 3 in the Service Units/Days or Units box.

    (The four-minute increment is not reimbursable.)

    ; For 80 minutes of anesthesia time actually spent with the

    patient, enter 6 in the Service Units/Days or Units box.

    (The five-minute increment is reimbursable.)

     Note: Do not include the base units for the procedure performed

    since the base unit payment is automatically included in the

    reimbursement rate. Billing for the base units could be

     considered a fraudulent billing practice.

Start, Stop and Total Claims billing for more than 40 units of time (10 hours) require that an

    Anesthesia Time anesthesia report be attached to the claim. The anesthesia report

    must include anesthesia start, stop and total times.

    CPT-4 Code 01967 For CPT-4 code 01967 (neuraxial labor analgesia/anesthesia for Billing Requirements: planned vaginal delivery [includes any repeat subarachnoid needle

    placement and drug injection and/or any necessary replacement of an

    epidural catheter during labor]), all claims of 20 units or more require

    that an anesthesia report be attached.

    Note: Claims for 19 units or less for code 01967 do not require

    detailed documentation on the claim form or an attachment

    “Time in Attendance” If billing for obstetrical regional anesthesia (CPT-4 code 01967), With the Patient in addition to the documentation requirements noted above, providers

    also must document “time in attendance” on the attached anesthesia

    report. Claims without such documentation will be denied. Only time

    in attendance with the patient may be billed.

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    “Time in attendance” is time when the anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) monitors the patient receiving neuraxial labor analgesia, and the anesthesiologist or CRNA is readily and immediately available in the labor or delivery suite. If the actual time in attendance is less than the total quantity billed (in either the Service Units or Days or Units box), the claim will be reimbursed for

    the time in attendance with the patient. If two or more patients receive neuraxial analgesia concurrently, no more than four total time units per hour may be billed and must be apportioned among the claims, including claims to other insurance carriers.

    Example: Patients A and B receive overlapping labor analgesia: Patient A from 0500 to 1415 and Patient B from 0930 to 1245. See the following sets of instruction to bill for patient A and patient B.

Patient A claim completion instructions:

Field/Claim Type Enter

    Service Units field (Box 46) on the 31

    UB-04 claim

    Days or Units field (Box 24G) on the

    CMS-1500 claim

    Remarks field (Box 80) on the UB-04 SEE

    claim ATTACHMENT

    Reserved for Local Use field (Box 19) on

    the CMS-1500 claim

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     Required documentation will not fit in the designated area of the claim,

    so providers should enter the words “See Attachment” in the Remarks

    field (Box 80)/Reserved for Local Use field (Box 19) of the claim. For

    this example providers would submit the following exact statement on

    an attachment to the claim (following specific instructions under

    “Attachments” in the Forms: Legibility and Completion Standards

    section of this manual):

     Epidural anesthesia start time: 0500. Stop time: 1415.

    Time in attendance: 458 minutes (0500 0930 = 270 minutes;

    0930 1245 = 195 minutes, divided by 2 for overlapping

    time = 98 minutes; 1245 1415 = 90 minutes. 270+98+90 = 458)

    Patient B claim completion instructions:

    Field/Claim Type Enter

    Service Units field (Box 46) on the 7

    UB-04 claim

    Days or Units field (Box 24G) on the

    CMS-1500 claim

    Remarks field (Box 80) on the UB-04 SEE

    claim form ATTACHMENT

    Reserved for Local Use field (Box 19) on

    the CMS-1500 claim

     Required documentation will not fit in the designated area of the claim,

    so providers should enter the words “See Attachment” in the Remarks

    field (Box 80)/Reserved for Local Use field (Box 19) of the claim. For

    this example providers would submit the following exact statement on

    an attachment to the claim (following specific instructions under

    “Attachments” in the Forms: Legibility and Completion Standards

    section of this manual):

     Epidural anesthesia start time: 0930. Stop time: 1245. Time in

    attendance: 98 minutes (0930 1245 = 195 minutes, divided by 2

    to split overlapping time = 98 minutes).

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Obstetrical Anesthesia Providers billing codes 01958, 01960 01963, 01965, 01966, 01968

    Documentation 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 must document “time

    in attendance” (in addition to “start-stop” times for general anesthesia,

    if billed for both) on the anesthesia report.

    Billing Obstetrical Anesthesia Add-on codes must be billed in conjunction with the primary Add-On Codes anesthesia code. For an example, refer to the Anesthesia Billing

    Examples section of this manual.

    Total Anesthesia Time Unit: The preceding policy applies to all anesthesia services, except when Less Than Five Minutes the total anesthesia time being billed is less than five minutes. In

    these situations, one increment of anesthesia time is reimbursable.

     When billing for anesthesia time that is less than five minutes, enter 1

    in the Service Units/Days or Units