1 Ten Steps to Coding Anesthesia Services AAPC National Conference Orlando, Florida April 2013 Chandra Stephenson, CPC, CPC-H, CPMA, CPC-I, CANPC, CEMC, CFPC, CGSC, CIMC, COSC
2 Disclaimer The information in this presentation was current at the time the presentation was complied and does not include specific payer policies or contract language. Always consult CPT, CMS, and your payers for specific guidance in reporting services. The views expressed in this presentation are simply my interpretations of information I have read, compiled and studied. Much of the information is directly from the AMA, ASA, AAPC, CMS literature and other reputable sources.
3 Objectives Coding Identify resources and documentation needed to code anesthesia services Establish a simple, structured process for coding anesthesia services Documentation Compliance Identify information needed to code anesthesia services routinely missing from the medical record Identify ASA documentation requirements anesthesia providers and coders need to know
4 Types of Anesthesia Topical infiltration Local anesthesia Metacarpal/Metatarsal/Digital blocks ==================================== Regional anesthesia Peripheral nerve blocks Epidural or spinal anesthesia Monitored anesthesia care (MAC) General anesthesia
5 Levels of Sedation Responsiveness Minimal Sedation Anxiolysis Normal response to verbal stimulation Moderate Sedation/ Analgesia Purposeful** response to verbal or tactile stimulation Airway Unaffected No intervention required Spontaneous Ventilation Cardiovascular Function Deep Sedation/ Analgesia Purposeful** response following repeated or painful stimulation Intervention may be required Unaffected Adequate May be inadequate Unaffected Usually maintained Usually maintained General Anesthesia Unarousable even with painful stimulus Intervention often required Frequently inadequate May be impaired ASA Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia
6 Who Makes the Rules? AMA American Medical Association ASA American Society of Anesthesiologists CMS Center for Medicare and Medicaid Services
7 ASA Standards Provide rules or minimum requirements for clinical practice Guidelines Systematically developed recommendations that assist the practitioner and patient in making decisions about health care Statements Represent the opinions, beliefs, and best medical judgments of the House of Delegates Guidelines-and-Statements.aspx
8 Resources Needed CPT book ICD-9-CM book HCPCS book ASA Crosswalk ASA Relative Value Guide
9 ASA Resources Relative Value Guide (RVG) Numeric value assigned to a procedure in relation to other procedures in terms of work and cost (similar to RVUs) Base Units Anesthesia Crosswalk Links surgical procedure(s) performed to the appropriate anesthesia service code
10 Documentation Needed Pre-anesthesia record completed by the anesthesia provider Anesthesia report completed by the anesthesia provider Post-anesthesia record completed by the anesthesia provider and the postanesthesia care unit (PACU) team Surgeon s operative report
13 What s Included? Pre-operative and post-operative visit General or regional anesthesia and patient care Administration of fluids and/or blood Usual monitoring services (eg, ECG, temperature, blood pressure, oximetry, capnography, and mass spectrometry)
14 Bundled Services Laryngoscopy (31505, 31515, 31527) Bronchoscopy (31622, 31645, 31646) Introduction of needle or catheter ( ) Venipuncture or transfusion ( ) Blood sample procurement through existing lines
16 Bundled Services (cont.) Retrobulbar injection (67500) Interpretation of lab tests ( , 82013, 82205, 82270, 82271) Injections and IV drug administration ( ) Esophageal, gastric intubation (91000, 91055, 91105)
17 Bundled Services (cont.) Injection of diagnostic or therapeutic substances ( , ) Nerve blocks ( ) Transesophageal echo (TEE) ( ) Each of the three services listed above may be separately reportable in certain circumstances. In those circumstances, modifier 59 should be appended to the CPT code for the procedure(s) performed.
18 10 Steps 1. Determine the appropriate CPT code(s) for the surgical procedure(s) performed. 2. Crosswalk the CPT code(s) to the appropriate ASA code. 3. Determine the appropriate number of base units. 4. Determine the appropriate number of time units. 5. Assign the appropriate modifier to identify the anesthesia provider.
19 10 Steps (cont.) 6. Assign the appropriate modifier to identify MAC services, when appropriate. 7. Assign the appropriate physical status modifier. 8. If applicable, assign the appropriate qualifying circumstance code(s). 9. Determine the appropriate CPT code(s) for any additional services or procedures performed. 10.Determine the total units for the anesthesia services.
21 Step 1: CPT Code for Procedure Surgeon performs an excision of a benign tumor on the olecranon process CPT Code: 24120
22 Multiple Procedures Crosswalk all surgical procedures performed Select the anesthesia code with the highest base units value Only one ASA code is reported Report the total anesthesia time
23 Step 2: Crosswalk Surgeon performs an excision of a benign tumor on the olecranon process CPT Code: CPT ASA Units TM Anesthesia for open or surgical arthroscopic procedures of the elbow; not otherwise specified
24 Multiple Procedures Example Procedures Performed: Closed treatment of proximal fibula or shaft fracture CPT Code: ASA Crosswalk: ASA Base Units: 3 Revision of total hip arthroplasty CPT Code: ASA Crosswalk ASA Base Units: 10
25 Multiple Crosswalk Options Procedure: Coronary artery bypass, vein only (33510) ASA Crosswalk Options: Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, age 1 or older for all non-coronary bypass procedures or for reoperation for coronary bypass more than 1 month after original operation (Base = 20) Anesthesia for direct coronary artery bypass grafting; without pump oxygenator (Base = 25) Anesthesia for direct coronary artery bypass grafting; with pump oxygenator (Base = 18)
26 Step 3: Base Units ASA-RVG Base Unit Exceptions Procedures of the head, neck, or shoulder girdle requiring field avoidance Procedures performed in a position other than supine or lithotomy For either of the above circumstances, a minimum base unit of 5 should be used.
27 Patient Positions Lithotomy
28 Step 4: Time Units Anesthesia Time Begins: When the anesthesia provider prepares the patient for the induction of anesthesia in the operating room or equivalent area Ends: When the anesthesia provider is no longer in personal attendance (patient is safely placed under post-operative supervision)
29 Step 4: Time Units (cont.) AMA and ASA recommend that 1 unit of time is equal to 15 minutes of anesthesia time Time is rounded up to the next unit after 7 ½ minutes is reached. Some carriers, including Medicare, do not follow the above recommendation. Refer to your local payer contracts and policies for specific guidance for reporting time.
30 Step 4: Time Units (cont.) Medicare Requires the actual anesthesia time (total number of minutes) be reported in box 24G of the CMS-1500 claim form Computes time units as one unit per 15- minute time period and rounds time unit to one decimal place Minute Unit Minute Unit
31 Step 5: Anesthesia Provider Modifier AA Description Anesthesia services performed personally by anesthesiologist AD QK QY QX Medical supervision by a physician: more than four concurrent anesthesia procedures Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist CRNA service: with medical direction by a physician QZ CRNA service: without medical direction by a physician
32 Medicare and Medical Direction Qualified Individuals CRNAs AAs Interns Residents* Student nurse anesthetists
33 Medicare and Medical Direction 1. Perform pre-anesthetic exam and evaluation 2. Prescribe the anesthesia plan 3. Personally participate in the most demanding procedures in the anesthesia plan 4. Ensures procedures that are not personally performed are performed by a qualified individual 5. Monitors the course of anesthesia in frequent intervals 6. Remains physically present and available for emergencies 7. Provides indicated post-operative care
34 Teaching Physician Guidelines Teaching physician must: Be immediately to furnish services during the entire procedure Document Presence during all critical (or key) portions of the procedure Involvement in cases with residents Availability of another teaching anesthesiologist as necessary Report Modifier AA Modifier GC
35 Step 6: MAC Services Modifier QS Description Monitored anesthesia care service G8 G9 Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure Monitored anesthesia care for patient who has history of severe cardiopulmonary condition If a service is intended to be MAC and at any point the patient is unable to control their own airway, the service is no longer considered a MAC service and should be reported as general anesthesia.
36 Step 7: Physical Status Modifier Description Base Unit Value P1 A normal health patient 0 P2 A patient with mild systemic disease 0 P3 A patient with severe systemic disease 1 P4 P5 P6 A patient with severe systemic disease that is a constant threat to life A moribund patient who is not expected to survive without the operation A declared brain-dead patient whose organs are being removed for donor purposes 2 3 0
37 Physical Status Mortality Rates ASA Physical Status Dripps et al 1961 Marx et al :9, : 1,013 1: 10, : 151 1: : 22 1: :11 1: 64 Introduction to Anesthesia Robert Dunning Dripps, James E. Eckenhoff, Leroy D. Vandam Saunders Publishing
38 Step 8: Qualifying Circumstances CPT Code Description Base Unit Value Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure) Anesthesia complicated by utilization of total body hypothermia (List separately in addition to code for primary anesthesia procedure) Anesthesia complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure) Anesthesia complicated by emergency conditions (List separately in addition to code for primary anesthesia procedure)
39 99100 Exceptions Anesthesia for all procedures on the larynx and trachea in children younger than 1 year of age Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age
40 99100 Exceptions (cont.) Anesthesia for hernia repairs in the lower abdomen not otherwise specified, younger than 1 year of age Anesthesia for hernia repairs in the lower abdomen not otherwise specified, infants younger than 37 weeks gestational age at birth and younger than 50 weeks gestational age at time of surgery
41 Step 9: Additional Procedures Insertion of central venous catheter ( , ) Insertion of an intra-arterial catheter ( ) Insertion of Swan-Ganz (93503) Transesophageal Echocardiography (TEE) ( ) Procedures performed for post-operative pain management
42 Line Placements When was the line placed? Who placed the line? Reportable by the anesthesia provider: The anesthesia provider Not reportable by the anesthesia provider: The surgeon Another provider Was the CVP used to thread the Swan-Ganz catheter? If so, only the Swan-Ganz is separately reportable How many lines are there?
43 Transesophageal Echocardiography Reportable by the anesthesia provider: When performed for diagnostic or therapeutic purposes and supported by the documentation Modifier 59 should be appended to the CPT code for the TEE
44 Post-Operative Pain Management Epidurals If epidural is route of administration for anesthesia, postoperative pain management is not separately reportable When separately reportable Based on spinal region Two types Single Injection ( )» is not appropriate Continuous Infusion or Intermittent Bolus ( )» Include catheter placement» Append modifier 59» Can report for subsequent daily hospital management Time placing the epidural must be carved out of the total anesthesia time
45 Spinal Anesthesia
46 Epidurals Needles Catheters From Miller: Miller s Anesthesia, 6th ed.
48 Post-Operative Pain Management (cont.) Nerve Blocks If epidural is route of administration for anesthesia, post-operative pain management is not separately reportable When separately reportable Based on the nerve being blocked Single Injection Continuous Infusion by Catheter Brachial plexus, sciatic nerve, femoral nerve, lumbar plexus Time performing block must be carved out of the total anesthesia time
49 Spinal Blocks
50 Step 10: Total Anesthesia Units Medicare Base Value + Time Units = Total Units Other Payers* Base Value + Time Units + Modifying Units = Total Units *Verify your payers policies and contracts for specific guidance for proper determination of calculating units.
52 Exceptions Anesthesia for Obstetric Services Anesthesia for Burn Excisions or Debridement
53 Anesthesia for Obstetrics Base units plus time units (insertion through delivery), subject to a reasonable cap Base units plus one unit per hour for neuraxial analgesia management plus direct contact time (insertion, management of adverse effects, delivery, removal) Incremental time-based fees (eg, 0<2 hrs, 2-6 hrs, >6 hrs) Single fee
54 Anesthesia for Obstetrics Vaginal labor and delivery converted to a Cesarean delivery Only anesthesia scenario in which each of the services reported require base and time units to be calculated Vaginal labor and delivery: Time: Anesthesia start time through decision for C-Section Cesarean delivery following labor analgesia: Time: Decision for C-Section through anesthesia end time
55 Anesthesia for Burn Excisions or Debridement Second- or third-degree burns treated during anesthesia and surgery Based on total body surface area (TBSA) 01951: less than 4% total body surface area 01951: 4% to 9% total body surface area or part thereof : each additional 9% total body surface area or part thereof
58 Safe Conduct Anesthesiologist directing the team is responsible for: Management of personnel Preanesthetic evaluation of the patient Prescribing the anesthetic plan Management of the anesthetic Postanesthesia care Postanesthetic complications Anesthesia consultation
59 Preanesthesia Documentation Patient interview, including Patient identification Procedure identification Verification of admission status Medical history Anesthetic history Medication and allergy history NPO status Assess aspects of patient s physical condition that might affect decisions regarding perioperative risk and management
60 Preanesthesia Documentation (cont.) Appropriate physical examination, including Vital signs Airway assessment Review of objective diagnostic data Review of available medical record Formulation of the anesthetic plan and discussion of the risks and benefits of the plan (including discharge issues when indicated) with the patient or the patient s legal representative and/or escort Records an assessment (diagnosis) Documentation of appropriate informed consent(s)
61 Preanesthesia Documentation (cont.) When applicable/indicated Medical consultations Assignment of ASA physical status, including emergent status when applicable Appropriate premedication and prophylactic antibiotic administrations
62 Preanesthesia Documentation (cont.) If the patient is a minor or is unable to communicate, this should be reflected in the documentation as should the source of the information obtained
63 Intra-operative Documentation Time-based record of events, including Immediate review prior to initiation of anesthetic procedures Patient re-evaluation Re-verification of NPO status Check of equipment Check of drugs supply Check of gas supply
64 Intra-operative Documentation (cont.) Technique used Patient position(s) Any unusual events during the administration of anesthesia Status of the patient at the conclusion of anesthesia
65 Intra-operative Documentation (cont.) Monitoring of the patient Oxygenation Ventilation Circulation Body Temperature Doses of drugs and agents used Times of administration Routes of administration Any adverse reactions
66 Intra-operative Documentation (cont.) Type of IV fluids used* Amounts of IV fluids used Times of IV fluid administration Intravenous/Intravascular lines inserted Technique for insertion Location Airway devices inserted Technique for insertion Location *IV fluids includes blood and blood products
67 Postanesthesia Documentation Anesthesia provider Patient evaluation on admission to post anesthesia care unit (PACU) Anesthesia provider/pacu Nurse Patient evaluation on discharge from PACU Any unusual events during the administration of anesthesia Postanesthesia visits
68 Postanesthesia Documentation (cont.) Anesthesia provider/pacu Nurse Time-based record of Vital signs Level of consciousness Drugs administered Dosage Route of administration Type of IV fluids used Amounts of IV fluids used
69 Resources Utilized 2013 CPT Professional Edition 2012 ICD-9-CM 2013 HCPCS Level II 2013 ASA Relative Value Guide 2013 ASA Crosswalk 2013 Coding and Payment Guide for Anesthesia Services CMS Claims Processing Manual, Chapter 12, Section 50 ASA Standards Guidelines and Statements The Anesthesia Care Team (2009) Documentation of Anesthesia Care (2008) Basic Standards for Preanesthesia Care (2009) Standards for Postanesthesia Care (2009)
1570 Midway Pl. Menasha, WI 54952 920-720-1300 Procedure 1205- Anesthesia Lines of Business: All Purpose: This guideline describes Network Health s reimbursement of anesthesia services. Procedure: Anesthesia
ANESTHESIA SERVICES Policy NHP reimburses participating providers for the administration of general and regional anesthesia, and supportive services performed in conjunction with covered obstetrical, surgical,
What You Need to Know About Anesthesia Filing Guidelines 2015 Edition Published by Provider Relations and Education Your Partners in Outstanding Quality, Satisfaction and Service This document provides
Policy Number 2016R0032B Anesthesia Policy Annual Approval Date 3/11/2015 Approved By REIMBURSEMENT POLICY CMS-1500 Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You
Private Property of Florida Blue. This payment policy is Copyright 2012, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission
Anesthesia Policy Policy Number 2015R0032D Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission
IMPORTANT NOTICE REGARDING NEW ANESTHESIA BILLING GUIDELINES AND REIMBURSEMENT PROCEDURES February 2010 This notice will serve as an update to the November 2008 Anesthesia Billing Guidelines and Reimbursement
Anesthesia Payment & Billing Information Time and Points Eligible Anesthesia Procedures Defined HMO Blue Texas SM and Blue Cross and Blue Shield of Texas have determined that certain anesthesia procedures
NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden
Anesthesia Processing Manual Important Information The following disclaimer is applicable to all telephone inquiries and automated communications systems (i.e., telephone and fax) to Blue Cross and Blue
Anesthesia Services Policy Number ANES08272009RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 08/27/2014 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable
ANESTHESIA BILLING AND REIMBURSEMENT POLICY Payment policies apply to all in-network and out-of-network providers who render services to Neighborhood Health Plan of Rhode Island subscribers covered under
EqualityCareNews October 2006 Coverage ATTENTION PROVIDERS Anesthesia Services Effective 12/1/06 CMS-1500 Bulletin 06-009 EqualityCare covers anesthesia only when administered by a licensed anesthesiologist
CHAP2-CPTcodes00000-01999_final103115.doc Revision Date: 1/1/2016 CHAPTER II ANESTHESIA SERVICES CPT CODES 00000-09999 FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES Current
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Anesthesia Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 1 9 P U B L I S H E D : F E B R U A R Y 25, 2 0 1 6 P O L
Anesthesia Coding and Compliance Presented by: Melanie Lafferty June 2015 Conflict of Interest Disclosure Statement Melanie Lafferty, Vice President of Practice Management Medac, Inc. I have the following
Reimbursement Policy Subject: Professional Anesthesia Services Effective Date: 01/01/15 Committee Approval Obtained: 01/01/15 Section: Anesthesia ***** The most current version of our reimbursement policies
Billing & Compliance for Anesthesia Services Charles Whitten, MD Professor and Chairman Anesthesia Billing Anesthesia is a Unique Specialty ASA* vs. CPT codes Anesthesia Specific Modifiers Time based Billing
PARTNESHIP HEALTHPLAN OF CALIFORNIA HEALTHY KIDS CLAIMS DEPARTMENT VII.A. Anesthesia Billing To bill for anesthesia services, use the five-digit CPT-4 anesthesia code applicable to the procedure with the
PROVIDER BILLING GUIDELINES Anesthesia Background Qualified medical professionals administer anesthesia to relieve pain while at the same time monitoring and controlling the patients health and vital bodily
Anesthesia Coding and Compliance Presented by: Melanie Lafferty July 2014 Introduction The target for this training is to provide you with a basic understanding of anesthesia coding and compliance in regards
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-12-25 Baltimore, Maryland 21244-1850 Center for Medicaid and State Operations/Survey
Anesthesia Billing: 101 Presented by: Medi-Corp, Inc www.medi-corp.com Disclaimer Statement The material enclosed is based on information that is in effect at the time of this presentation. This presentation
Anesthesiology Billing How to Ensure Proper Reimbursement and Avoid a RAC Audit Table of Contents Introduction: The Aggressive RAC Audit... 2 Common Audit Problems How to Prevent an Audit: Key Points to
Preface Summary of Changes Table of Contents Service Contacts November 2014 Replaces: September 2014 S-5787 11/14 Preface The Wellmark Provider Guide and specialty guides are billing resources for providers
Mississippi Board of Nursing Regulating Nursing Practice www.msbn.state.ms.us 713 Pear Orchard Road, Suite 300 Ridgeland, MS 39157 Administration and Management of Intravenous (IV) Moderate Sedation POSITION
Private Property of Florida Blue. This payment policy is Copyright 2012, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission
Analgesia and Moderate Sedation This Nebraska Board of Nursing advisory opinion is issued in accordance with Nebraska Revised Statute (NRS) 71-1,132.11(2). As such, this advisory opinion is for informational
Scope and Standards for Nurse Anesthesia Practice Copyright 2013 222 South Prospect Ave. Park Ridge, IL 60068 www.aana.com Scope and Standards for Nurse Anesthesia Practice The AANA Scope and Standards
INTEGRATING ANESTHESIOLOGIST ASSISTANTS INTO YOUR PRACTICE: WHAT YOU NEED TO KNOW Jay Mesrobian, M.D. John Stephenson, M.D. David Biel, AA C Michael Nichols, AA C I Introduction Incorporation of Anesthesiologist
American Association of Nurse Anesthetists 222 South Prospect Avenue Park Ridge, IL 60068 www.aana.com Guidelines for the Management of the Obstetrical Patient for the Certified Registered Nurse Anesthetist
Medical Coverage Policy Monitored Anesthesia Care (MAC) Device/Equipment Drug Medical Surgery Test Other Effective Date: 9/1/2004 Policy Last Updated: 1/8/2013 Prospective review is recommended/required.
Medical Coverage Policy Monitored Anesthesia Care (MAC) sad EFFECTIVE DATE: 09 01 2004 POLICY LAST UPDATED: 11 04 2014 OVERVIEW The intent of this policy is to address anesthesia services for diagnostic
Scope and Standards for Nurse Anesthesia Practice Copyright 2010 222 South Prospect Ave. Park Ridge, IL 60068 www.aana.com Scope and Standards for Nurse Anesthesia Practice The AANA Scope and Standards
Anesthesia Module Anesthesia Billing Anesthesia billing is unique for the following reasons: CPT to ASA mapping Unit Calculation Fee/Expected Fee Calculation Resident Billing CRNA Billing Concurrency Concurrency
POLICIES AND PROCEDURES GOVERNING ANESTHESIA PRIVILEGING IN HOSPITALS **Hospitals must review and revise with legal counsel and ensure compliance with State and federal laws and regulations. ASA intends
Suzanne Honor-Vangerov, Esq. CPC, CPC-I 1 Managing Attorney, Lien Unit Floyd Skeren & Kelly LLP Owner of Honor System Consulting Prior Manager of the Division of Workers Compensation Medical Unit, in charge
Payment Policies Appendices Appendix E: Modifiers that affect payment Note: Only modifiers that affect payment are listed in this Appendix. Refer to current CPT and HCPCS books for a complete list of modifiers,
PROVIDER BILLING GUIDELINES Modifiers Modifiers are two digit or alphanumeric characters that are appended to CPT and HCPCS codes. The modifier allows the provider to indicate that a procedure was affected
Department of Anesthesiology (Jax) College of Medicine Jacksonville Anesthesiology Billing Compliance Plan Revised October 1, 2015 I. Billing Compliance Administrative Policies and Procedures 1.0 INTRODUCTION
Summary: CH CONSCIOUS SEDATION It is the policy of Carondelet Health that moderate conscious sedation of patients will be undertaken with appropriate evaluation and monitoring. Effective Date: 9/4/04 Revision
Pat Cox, CPC, CPC-H, CPMA, CPC-I, CEMC, CCS-P Professional Medical Coding Education Thank you for your interest in the upcoming Certified Professional Coder (CPC ) class. This session is a 16-week class
BEFORE THE ALABAMA BOARD OF NURSING IN THE MATTER OF: ) PETITION FOR ) DECLARATORY RULING STEVE SYKES, M.D., ) ) ) Petitioner. ) DECLARATORY RULING COMES NOW the Alabama Board of Nursing, by and through
Table of Contents ILLINOIS WORKERS' COMPENSATION COMMISSION MEDICAL FEE SCHEDULE INSTRUCTIONS AND GUIDELINES For treatment before 2/1/09 Introduction and Purpose Reference Materials Section 1. Ambulatory
Chapter VI Scoring: Standard AN.1. A qualified Anesthetist administers all anesthesia. AN.2. One Anesthetist is physically present inside the operating room throughout the operation. AN.3. The Anesthetist
Official Group Of SAMA Association Not For Gain T: +27 (0) 86 010 3137 (toll free) T: +27 (0) 31 368 2530 F +27 (0) 86 242 9804 E: email@example.com PO Box 1935, Durban, 4000, South Africa www.sasaweb.com
POLICY.........PG0011 EFFECTIVE......10/30/05 LAST REVIEW... 10/13/15 MEDICAL POLICY Modifier Guidelines GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated
CAUTION: Read the ICD-9 Policy Holding Library page about policy in this document. anest cms Anesthesia Billing Examples: CMS-1500 1 Examples in this section are to assist providers in billing for Anesthesia
The Medical Clean Claims Task force has developed this modifier grid to identify modifiers that are considered to be important in the overall adjudication of a claim from a commercial payer perspective.
BILLING COMPLIANCE PLAN: DOCUMENTATION AND VERIFICATION OF THE ANESTHETIC CARE FOURTH ADDITION DEPARTMENT OF ANESTHESIOLOGY UNIVERSITY OF TEXAS MEDICAL BRANCH GALVESTON, TEXAS REVISED APRIL 2009 1 of 22
Modifiers A Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) modifier is a twocharacter (alpha and/or numeric) code appended to a CPT/HCPCS procedure code to clarify
Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement Many patients with emergency medical conditions in emergency and critical care settings frequently experience treatable pain,
The Scope of Practice of Nurse Anesthetists American Society of Anesthesiologists January 2004 Table of Contents Preface.................................................................................
DEPARTMENT OF ANESTHESIOLOGY DELINEATION OF PRIVILEGES THE DETROIT MEDICAL CENTER Applicant Name: QUALIFICATIONS FOR: Note: If any privilege(s) are covered by an exclusive contractual agreement, physicians
50 SHADES OF GREY: OIG AUDITS OF ACADEMIC ANESTHESIA DEPARTMENTS Stanley W. Stead, M.D., M.B.A. President, Stead Health Group, Inc. Section Chair, ASA Section on Professional Practice AMA Relative Value
Anatomical modifiers Anesthesia modifiers EA, EB and EC FB, FC and FD Anatomical modifiers are used to indicate that a procedure or service was performed at a specific anatomic site or to indicate that
MEDICARE J14 A/B MAC PART B RT B Anesthesia Billing Guide October 2010 NHIC, Corp. The NHIC, Corp. 2 October 2010 Table of Contents Introduction... 5 General Information... 6 Provider Qualifications...
Guidelines for the Practice of Anesthesia in Norway History 1991 1st version 1994 1st revision 1998 2nd revision 2005 3rd revision on 19.03.05 by NAF (The Norwegian Society of Anesthesiology) 1 Table of
ECRI Institute Perspectives Postanesthesia care action plan aims to ensure optimal patient safety The most important room in the hospital : that s what a landmark 1969 case in Canada Laidlaw v. Lions Gate
MAKING DOLLAR$ AND $ENSE FROM A CARDIAC ANESTHESIA PRACTICE Christopher A. Troianos, MD Professor and Chair of Anesthesiology Western Pennsylvania Hospital West Penn Allegheny Health System Western Campus
MEDICARE CLAIMS PROCESSING MANUAL Accessed September 25, 2005 100.1 - Payment for Physician Services in Teaching Settings Under the MPFS Payment is made for physician services furnished in teaching settings
The Impact of Regional Anesthesia on Perioperative Outcomes By Dr. David Nelson As a private practice anesthesiologist, I am often asked: What are the potential benefits of regional anesthesia (RA)? My
Subject: Modifier Rules NY Policy: 0017 Effective: 02/01/2014 06/30/2014 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
CODE AUDITING RULES As part of Coventry Health Care of Missouri, Inc s commitment to improve business processes, we are implemented a new payment policy program that applies to claims processed on August
REFERENCES: The Joint Commission Accreditation Manual for Hospitals American Society of Post Anesthesia Nurses: Standards of Post Anesthesia Nursing Practice (1991, 2002). RELATED DOCUMENTS: SHC Administrative
WORKERS' COMPENSATION MEDICAL FEE SCHEDULE RULE 40.000 40.000 Workers' Compensation Medical Fee Schedule The five-digit numeric codes and descriptions included in Rule 40.000, Medical Fee Schedule, are
Regions Hospital Delineation of Privileges Certified Registered Nurse Anesthetist Applicant s Name: Last First M. Instructions: Place a check-mark where indicated for each core group you are requesting.
Guidelines for the Use of Sedation and General Anesthesia by Dentists I. Introduction The administration of local anesthesia, sedation and general anesthesia is an integral part of dental practice. The
TABLE 2 ASA Physical Status Classification ASA Class I II III IV V Description A normal, healthy patient, without organic, physiologic, or psychiatric disturbances A patient with controlled medical conditions
Boulder Community Health Medical Staff Department Nurse Practitioner Privileges Name: Please print To be eligible to request clinical privileges, the applicant must meet the following threshold criteria:
Oregon CO-OP Modifier Table - December 2013 Modifier Modifier Description Pricing Functionality 22 Increased Procedural Services Modifier 22 should only be reported with procedure codes that have a global
Application for Educational Membership Personal Information (Please print or type) Name: (Full Legal Name) Date: Date of Birth: Gender: Male Female Address: Suite No: City: State: ZIP: * E-mail: Do Not
Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 44 BOARD OF DENTAL EXAMINERS Chapter 12 Anesthesia and Sedation Authority: Health Occupations Article, 4-205 Annotated Code of Maryland.01 Scope.
1. ANESTHESIA Anesthesia Preamble The tariff is for all types of anesthetic service. This includes general and regional anesthesia, resuscitation and critical care, monitored anesthesia care, and any other
Credentialing Criteria for Privileges to Administer Sedation/Analgesia by the Non- Anesthesiologist Administrative Policy & Procedure - Jersey Shore University Medical Center Document Number: JM-ADMIN-0004
Physician Services Anesthesia Contacting Wisconsin Medicaid Web Site dhfs.wisconsin.gov/ The Web site contains information for providers and recipients about the following: Program requirements. Publications.
OHIP BILLING for ANESTHESIOLOGY (Updated September 13, 2011) Introduction Review the SOB (Schedule of Benefits) on line at either the OMA website or the MOHLTC website http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html.