Thursday, 26 January 2017

Anesthesia with Manipulation CPT codes

CPT Codes:

21073  Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care) 
22505     Manipulation of spine requiring anesthesia, any region 
23700   Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded) 
24300     Manipulation, elbow, under anesthesia 
25259     Manipulation, wrist, under anesthesia 
26340     Manipulation, finger joint, under anesthesia, each joint 
27194  Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; with manipulation, requiring more than local anesthesia 
27275     Manipulation, hip joint, requiring general anesthesia 
27570  Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices) 
27860     Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus) 

Proven Diagnosis Codes:

718.51     Ankylosis of joint of shoulder region 
718.52     Ankylosis of upper arm joint 
718.56     Ankylosis of lower leg joint 
726.0     Adhesive capsulitis of shoulder 
733.19     Pathologic fracture of other specified site 
805.6     Closed fracture of sacrum and coccyx without mention of spinal cord injury 
806.61: Closed fracture of sacrum and coccyx with complete cauda equina lesion 
806.62 : Closed fracture of sacrum and coccyx with other cauda equina injury 
806.79 : Open fracture of sacrum and coccyx with other spinal cord injury 
808.0 : Closed fracture of acetabulum 
808.2 : Closed fracture of pubis 
808.41 : Closed fracture of ilium 
808.42 : Closed fracture of ischium 
808.43 : Multiple closed pelvic fractures with disruption of pelvic circle 
808.49 : Closed fracture of other specified part of pelvis 
812.4   : Closed fracture of lower end of humerus (Incomplete code - additional digit required) 
813.01     Closed fracture of olecranon process of ulna 
839.41     Closed dislocation, coccyx 
839.42     Closed dislocation, sacrum 
839.69     Closed dislocation, other location 
V43.65     Knee joint replacement by other means

Unproven Diagnosis Codes:

524.60     Unspecified temporomandibular joint disorders 
524.69     Other specified temporomandibular joint disorders 
718.25     Pathological dislocation of pelvic region and thigh joint 
718.54     Ankylosis of hand joint 
718.55     Ankylosis of pelvic region and thigh joint 
718.57     Ankylosis of ankle and foot joint 
808.43     Multiple closed pelvic fractures with disruption of pelvic circle

Anesthesia CPT code that require authorization

Anesthesiologists are NOT required to request prior authorization. The surgeon must obtain prior authorization when required for procedures identified in the Medical and Surgical Procedure Code List included with the Utah Medicaid

Provider Manual for Physician Services.

The anesthesiologist is required to enter the prior authorization number obtained by the surgeon for the CPT code when billing an ASA code related to a CPT procedure for a hysterectomy, sterilization or abortion. The ASA procedure codes listed below are associated with surgical codes that may require prior authorization by Medicaid.

If federal requirements for obtaining prior authorization for a hysterectomy, sterilization or abortion are not met,Medicaid cannot reimburse either the physician or the anesthesiologist. Exceptions (to the requirement that the surgeon obtain Prior Authorization before the procedure is performed) can be considered ONLY under one of the following circumstances:

1. The procedure was performed in a life-threatening or justifiable emergency situation.
2. Medicaid is responsible for the delay in prior authorization.
3. The patient is retroactively eligible for Medicaid.

Retroactive authorization for services related to these exceptions may be granted "after-the-fact" with appropriate documentation and review. If approved, the associated ASA code may also be reimbursed.

For additional information about the prior authorization process, refer to the Utah Medicaid Provider Manual, SECTION I, or contact Medicaid Information.

ASA Codes Associated with CPT Codes That May Require Prior Authorization

00402 Anesthesia for reconstructive breast procedures (reduction, augmentation, muscle flaps)

00580 Anesthesia for heart transplant or heart-lung transplant

00796 Liver transplant (recipient)

00840 Anesthesia for intraperitoneal procedures in lower abdomen (hysterectomy and sterilization)

00846 Anesthesia for radical hysterectomy

00848 Anesthesia for pelvic exenteration

00855 Anesthesia for cesarean hysterectomy

00922 Anesthesia for seminal vesicles

00926 Male, external genitalia; radical orchiectomy, inguinal

00928 Anesthesia for inguinal orchiectomy

00932 Anesthesia for complete amputation of penis

00934 Anesthesia for radical amputation of penis with bilateral inguinal lymphadenectomy

00936 Anesthesia for radical amputation of penis with bilateral inguinal and iliac lymphadenectomy

00940 Anesthesia for abortion procedures

00944 Anesthesia for vaginal hysterectomy

00952 Anesthesia for hysteroscopy

Concurrent Medically Directed Anesthesia Procedures

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.

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