Billing for Anesthesia Services

Claims Documentation Requirements

Submit claims for anesthesia services on the CMS-1500 claim form or the electronic equivalent. Use specific CPT American Society of Anesthesiology (ASA) anesthesia codes or surgical codes with the appropriate anesthesia modifier. For authorized surgical services, MHCP prefers that anesthesia services are billed using surgical procedure codes with the appropriate anesthesia modifier.

Anesthesiologists and CRNAs must comply with MHCP requirements for billing sterilization procedures. Submit a Sterilization Consent Form, signed and dated by the recipient and the physician, with anesthesia claims for sterilization procedures.

Exact Minutes

Submit the exact number of minutes from the preparation of the patient for induction to the time when the anesthesiologist or the CRNA was no longer in personal attendance or continues to be required. Enter only the number of minutes in the units box. MHCP will calculate the base units for each procedure.

Modifiers

To properly identify the exact nature of the service provided, use the following modifiers: 

Anesthesia Modifiers

AA - Anesthesia services performed personally by anesthesiologist

AD - Medical supervision by a physician: more than four concurrent anesthesia procedures

QK - Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals.

QS - Monitored anesthesia care services.

QX - CRNA service with medical direction by an anesthesiologist

QY - Anesthesiologist medically directs one CRNA

QZ - CRNA service without medical direction by an anesthesiologist

Conscious Sedation and Deep Sedation

Conscious Sedation

The intent of conscious sedation is for the patient to remain conscious and able to communicate during the entire procedure. 

The patient retains the ability to independently and continuously maintain a patent airway and respond appropriately to physical stimulation and/or verbal command. Conscious sedation includes performance and documentation of pre- and post sedation evaluations of the patient, administration of the sedation and/or analgesic agents, and monitoring of cardiorespiratory functions (pulse oximetry, cardio respiratory monitor, and blood pressure).

Conscious sedation may be administered by physicians (MDs) who have received training in moderate sedation. Follow 2006 CPT guidelines for the use of conscious sedation codes. Conscious sedation codes cannot be billed when anesthesia services are provided at the same time.

Deep Sedation

Deep sedation is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. 

Deep sedation may be administered by emergency medicine physicians (MDs) whose advance practice training has prepared them for airway management, advanced life support and rescue from any level of sedation.

Use the appropriate anesthesia or surgical procedure code to bill deep sedation and indicate the exact number of minutes in direct recipient contact. When deep sedation is performed by emergency medicine physicians, add modifier AA to the procedure code.

Monitored Anesthesia Care (MAC)

Monitored anesthesia care is a specific anesthesia service in which an anesthesiologist or CRNA has been requested to participate in the care of a patient undergoing a diagnostic or therapeutic procedure.

Monitored anesthesia care includes all aspects of anesthesia care: a pre-procedure visit, intraprocedure care and postprocedure anesthesia management. During monitored anesthesia care, the anesthesiologist or CRNA must be continuously physically present and provide a number of specific services, including but not limited to:

• Monitoring of vital signs, maintenance of the patient’s airway and continual evaluation of vital functions;

• Diagnosis and treatment of clinical problems that occur during the procedure;

• Administration of sedatives, analgesics, hypnotics, anesthetic agents or other medications as necessary to ensure patient safety and comfort;

• Provision of other medical services as needed to accomplish the safe completion of the procedure;

• Anesthesia care often includes the administration of doses of medications for which the loss of normal protective reflexes or loss of consciousness is likely. Monitored anesthesia care refers to those clinical situations in which the patient remains able to protect the airway for the majority of the procedure. 

If, for an extended period, the patient is rendered unconscious and/or loses normal protective reflexes, then anesthesia care shall be considered a general anesthetic.