Tuesday, 31 January 2017

Payment for Multiple Anesthesia Procedures and Add-On Codes

Multiple Anesthesia Procedures

Payment may be made under the fee schedule for anesthesia services associated with multiple surgical procedures or multiple bilateral procedures. 

Payment is based on the base unit of the anesthesia procedure with the highest base unit value and the total time units based on the multiple procedures with the exception of the new add-on codes. On the CMS-1500 claim form, report the anesthesia procedure code with the highest base unit value in Item 24D. In Item 24G, indicate the total time for all the procedures performed.

Add-On Codes

Add-on codes exist for anesthesia involving burn excisions or debridement and obstetrical anesthesia. The add-on code is billed in conjunction to the primary anesthesia code. In the burn area, code 01953 is used in conjunction with code 01952. In the obstetrical area, code 01968 or 01969 is used in conjunction with code 01967. 

All anesthesia time should be reported only with the primary anesthesia code involving burn excisions or debridement. Anesthesia time for the obstetrical codes should be reported separately on the primary code and the add-on code.

Anesthesia Billing and coding

Billing Instructions

Claims must be submitted on the claim Form CMS-1500 or electronic media claim equivalent.

The following are specific to anesthesia claims submission:

•Item  24D – the appropriate anesthesia modifier must be reported
•Item 24G – the actual anesthesia time, in minutes, must be reported.

Modifiers

Anesthesia modifiers must be used with anesthesia procedure codes to indicate whether the procedure was personally performed, medically directed, or medically supervised.

AA - Anesthesia services personally performed by the anesthesiologist
AD - Medical supervision by a physician; more than four concurrent anesthesia services
G8 -  Monitored anesthesia care (an informational modifier, does not affect reimbursement)
G9 -  MAC for at risk patient (an informational modifier, does not affect reimbursement)
QK -  Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
QS -  Monitored anesthesia care (an informational modifier, does not affect reimbursement)
QX -  CRNA service with medical direction by a physician
QY -  Medical direction of one CRNA by a physician
QZ -  CRNA service without medical direction by a physician

NOTE: Medicare does not recognize Physical Status P modifiers.

NOTE : Modifier QS versus Modifiers G8 or G9 should be used for Monitored Anesthesia Care.

Anesthesia provider 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.

How payment calculated for Anesthesia service?

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%

1 comment:


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