Anesthesia Services Effective 12/1/06

Size: px
Start display at page:

Download "Anesthesia Services Effective 12/1/06"

Transcription

1 EqualityCareNews October 2006 Coverage ATTENTION PROVIDERS Anesthesia Services Effective 12/1/06 CMS-1500 Bulletin EqualityCare covers anesthesia only when administered by a licensed anesthesiologist or a certified registered nurse anesthetist (CRNA) who remains in attendance for the sole purpose of rendering anesthesia in order to afford the patient anesthesia care deemed optimal during any procedure. The American Society of Anesthesiologists (ASA) relative value guide is accepted as the basis for coding and definition of anesthesia provided to Medicaid patients. Billing Anesthesia services may be billed either electronically or on a CMS-1500 claim form. Refer to billing instructions at wyequalitycare.acs-inc.com or in the EqualityCare CMS-1500 Billing Module. Specific Instruction for Anesthesia Billing When billing ASA procedure codes, enter actual minutes for procedures where time is necessary. For example, enter 65 minutes, rather than 1 hour 5 minutes. When billing using a paper claim form, enter the total time in minutes, in Box 24G of the CMS-1500 form. A specific diagnosis code must be used. REIMBURSEMENT FOR ANESTHESIA Anesthesia payments will be the lower of billed charges or a calculated fee. The Medicaid Management Information System (MMIS) calculates anesthesia reimbursement by adding Basic Value, plus Time Units and multiplying the total number of anesthesia values by a dollar conversion factor. That fee is then adjusted according to the appropriate anesthesia modifier.

2 A Basic Value is assigned for anesthetic management of most surgical procedures and is related to the complexity of the procedure. This basic value includes all usual anesthesia included in the Basic Value are the usual pre-operative and postoperative visits, the administration of fluids and /or blood products incident to the anesthesia care and interpretation of non-invasive monitoring. Time Units Time reporting for EqualityCare is computed at the rate of one time unit for each fifteen-minute or fraction therefore. Fractions of time are always rounded up to the next full number. Payment calculation per MMIS system = procedure anesthesia base units plus time units multiplied by the anesthesia conversion factor. Important Note: Anesthesia units must be billed in minutes. Do not convert or change time by dividing by 15, the MMIS does this automatically when the claim is processed. Documentation Requirements for Anesthesia: Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia care in the operating room or an equivalent area and ends when the anesthesiologist is no longer in personal attendance. Anesthesia care terminates when the patient may be safely placed under post-anesthesia supervision. Begin and end times must be documented in the anesthesia record and must be legible. Anesthesia is a global service just as the surgical procedure for which it is given. No pre- or post-operative services will be recognized for separate payment, including those for: a. Pain Management on the same day as surgery. b. Routine monitoring is included in the primary anesthesia and not reimbursed separately. For specific information regarding routine monitoring, refer to the current version of the ASA relative value guide. c. Larygnoscopy codes 31505, and are incidental or included within the anesthesia time. d. Any anesthesia substance administered at the time of the procedure for circumcision, cannot be billed separately as this is considered part of the global package. Obstetrical Anesthesia Time Reporting Neuraxial labor analgesia/anesthesia for planned vaginal delivery will be reimbursed as a global fee per the fee schedule and should be billed as 1 unit, not the number of minutes.

3 Global fee includes establishing and maintaining the anesthesia for the time the client requires it. If the anesthesia should continue into the next day, use procedure code When billing obstetrical anesthesia, indicate total time, in minutes. If two anesthesia codes are billed on the same day, (i.e. tubal ligation following vaginal deliver), documentation must be submitted with the claim to support the necessity of these services. In some circumstances, pain management services extend to the day following the C-section. In such cases, coverage will be provided through use of the following code: daily follow-up and management of epidural analgesia EqualityCare does not allow CPT on the same day as placement of an epidural catheter. When multiple procedures are performed during a single anesthetic administration, Equality- Care will pay the basic value for only one anesthesia procedure. When multiple surgical procedures are performed during a single anesthetic administration, the anesthesia code representing the most complex procedure is reported. The time reported is the combined total for all procedures. Anesthesia for multiple obstetrical procedures may be paid the basic values for both procedures in the following circumstances. Neuraxial analgesia/anesthesia for planned vaginal delivery which becomes a Cesarean delivery. Use code to begin the procedure. When C-section is imminent, discontinue use of and change to code and continue on with straight time as for a general surgery. Neuraxial analgesia/anesthesia for planned vaginal delivery followed by tubal ligation on same or the next day following delivery. Use code for delivery. Use code (new code) Intraperitoneal Lower Abdomen, Tubal ligation/ Transection.

4 ANESTHESIA MODIFIERS Report all anesthesias with the anesthesia five-digit procedure code (00100 through 01999) plus the addition of physical status modifier. The use of other optional modifiers may be appropriate. Physical Status Modifiers Physical Status modifiers are represented by the initial letter P followed by a single digit from 1 to 6. Example: P1 These modifiers indicate various levels of complexity of the anesthesia service provided. Modifier Description Reimbursement P1 A normal healthy patient. No change P2 A patient with mild systemic disease. No change P3 A patient with severe systemic disease. Additional 5% P4 P5 P6 A patient with severe systemic disease that is a constant treat to life. A moribund patient who is not expected to survive without the operation. A declared brain-dead patient whose organs are removed for donor purposes. Additional 10% Additional 15% Not covered When billing for anesthesia, indicate the appropriate physical status modifier. If a Physical Status Modifier is billed, additional payment if appropriate will be added to the claim payment. A service that is rarely provided, unusual, variable, or new may require a special report in determining medical appropriateness of the service. Pertinent information should include an adequate definition or description of the nature, extent, and need for the procedure; and the time, effort, and equipment necessary to provide the service.

5 Additional items which may be included are: complexity of symptoms final diagnosis pertinent physical findings diagnostic and therapeutic procedures concurrent problems follow-up care EqualityCare follows the correct coding initiatives of Medicare. Medicare considers these codes B status or bundled codes. The anesthesia of special circumstance is figured into the complexity status of the patient (physical status modifiers), the RVU of the procedure, and the time required for the procedure. Therefore, the special circumstance codes are not reimbursed separately. Anesthesiologists and CRNA s are not required to request prior authorization (PA) directly from EqualityCare for any anesthesia procedure. When billing for surgical procedures which require informed consent, a copy of the surgeon s consent form must be attached to the claim. This would include hysterectomy, sterilization and therapeutic abortion procedures. If you have additional questions regarding billing or covered services, please contact the ACS Provider Relations Unit at (307) or toll free at (800) Call center hours are Monday through Friday from 9am-5pm.

6 Important Changes! Please read! ACS, Inc P.O. Box 667 Cheyenne, WY PHONE: (800) IN CHEYENNE: (307) FAX: (307) We re on the Web!

IMPORTANT NOTICE REGARDING NEW ANESTHESIA BILLING GUIDELINES AND REIMBURSEMENT PROCEDURES. February 2010

IMPORTANT NOTICE REGARDING NEW ANESTHESIA BILLING GUIDELINES AND REIMBURSEMENT PROCEDURES. February 2010 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

More information

r JOHNS HOPKINS HEALTHCARE Physician Guidelines Subject: Anesthesia Processing Guidelines Lines of Business: EHP, USFHP, Priority Partners

r JOHNS HOPKINS HEALTHCARE Physician Guidelines Subject: Anesthesia Processing Guidelines Lines of Business: EHP, USFHP, Priority Partners Revision Date: 11/14/14 Last Reviewed Date: 11/14/14 Page 1 of 7 ACTION New Procedure Amending Procedure Number: Superseding Procedure Number: Repealing Procedure Number: REFERENCES: AMPT Committee ASA

More information

Anesthesia Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2016 Hewlett Packard Enterprise Development LP

Anesthesia Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2016 Hewlett Packard Enterprise Development LP 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

More information

Table of Contents A. General Billing Information.3 B. Reimbursement Guidelines...5 C. Documentation for Anesthesia Record...9

Table of Contents A. General Billing Information.3 B. Reimbursement Guidelines...5 C. Documentation for Anesthesia Record...9 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

More information

CODING AND COMPLIANCE NEW APPOINTMENT AND REAPPOINTMENT MODULE FOR ANESTHESIA FACULTY

CODING AND COMPLIANCE NEW APPOINTMENT AND REAPPOINTMENT MODULE FOR ANESTHESIA FACULTY CODING AND COMPLIANCE NEW APPOINTMENT AND REAPPOINTMENT MODULE FOR ANESTHESIA FACULTY ANESTHESIA BILLING: MUST BE DOCUMENTED AS: Personally performed: you perform the case without a resident or a CRNA

More information

CAUTION: Read the ICD-9 Policy Holding Library page about policy in this document.

CAUTION: Read the ICD-9 Policy Holding Library page about policy in this document. 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

More information

Anesthesia Payment & Billing Information

Anesthesia Payment & Billing Information 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

More information

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to:

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to: 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

More information

ANESTHESIA - Medicare

ANESTHESIA - Medicare ANESTHESIA - Medicare Policy Number: UM14P0008A2 Effective Date: August 19, 2014 Last Reviewed: January 1, 2016 PAYMENT POLICY HISTORY Version DATE ACTION / DESCRIPTION Version 2 January 1, 2016 Under

More information

Prerequisites. Authorization, Notification and Referral. Limitations ANESTHESIA SERVICES

Prerequisites. Authorization, Notification and Referral. Limitations ANESTHESIA SERVICES 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,

More information

Reimbursement Policy. Subject: Professional Anesthesia Services

Reimbursement Policy. Subject: Professional Anesthesia Services 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

More information

Anesthesia Guidelines

Anesthesia Guidelines Anesthesia Guidelines Updated April 2012 Anesthesia BlueCross requires anesthesiologists and certified registered nurse anesthetists (CRNAs) to file claims using CPT anesthesia codes. We cover general

More information

519.2 ANESTHESIA SERVICES. Background... 2. Policy... 2. 519.2.1 Covered Services... 2. 519.2.1.1 Anesthesiologist Directed Services...

519.2 ANESTHESIA SERVICES. Background... 2. Policy... 2. 519.2.1 Covered Services... 2. 519.2.1.1 Anesthesiologist Directed Services... TABLE OF CONTENTS SECTION PAGE NUMBER Background... 2 Policy... 2 519.2.1 Covered Services... 2 519.2.1.1 Anesthesiologist Directed Services... 3 519.2.1.2 Emergency Anesthesia... 4 519.2.1.3 Monitored

More information

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Anesthesia Policy Description: Definitions: This policy addresses

More information

Anesthesia Policy Annual Approval Date

Anesthesia Policy Annual Approval Date 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

More information

What You Need to Know About Anesthesia Filing Guidelines

What You Need to Know About Anesthesia Filing Guidelines 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

More information

Anesthesia Processing Manual

Anesthesia Processing Manual 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

More information

Modifier Reference PAYMENT POLICY ID NUMBER: 10-011. Original Effective Date: 05/14/10. Revised: 05/31/12 DESCRIPTION:

Modifier Reference PAYMENT POLICY ID NUMBER: 10-011. Original Effective Date: 05/14/10. Revised: 05/31/12 DESCRIPTION: 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

More information

The Basics of Anesthesia

The Basics of Anesthesia The Basics of Anesthesia Billing. Judy A. Wilson, CPC,CPC-H,CPC-P,CPC-I,CANPC,CMBSI,CMRS Disclosures This presentation is intended to provide basic educational information regarding coding/billing for

More information

PARTNESHIP HEALTHPLAN OF CALIFORNIA HEALTHY KIDS CLAIMS DEPARTMENT

PARTNESHIP HEALTHPLAN OF CALIFORNIA HEALTHY KIDS CLAIMS DEPARTMENT 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

More information

CODE AUDITING RULES. SAMPLE Medical Policy Rationale

CODE AUDITING RULES. SAMPLE Medical Policy Rationale 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

More information

Anesthesia Policy. Approved By 3/11/2015

Anesthesia Policy. Approved By 3/11/2015 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

More information

CAUTION: Read the ICD-9 Policy Holding Library page about policy in this document.

CAUTION: Read the ICD-9 Policy Holding Library page about policy in this document. CAUTION: Read the ICD-9 Policy Holding Library page about policy in this document. anest ub Anesthesia Billing Examples: UB-04 1 Examples in this section are to help providers bill for anesthesia services

More information

Modifiers. This modifier can be located in the following rule(s): Anesthesia Global Maternity

Modifiers. This modifier can be located in the following rule(s): Anesthesia Global Maternity 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.

More information

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

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 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

More information

Appendix E: Modifiers that affect payment

Appendix E: Modifiers that affect payment 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,

More information

Anesthesia Module. Anesthesia Billing

Anesthesia Module. Anesthesia Billing 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

More information

There are four anesthesia categories as determined by CMS that affect payment of anesthesia services based on the provider rendering the services:

There are four anesthesia categories as determined by CMS that affect payment of anesthesia services based on the provider rendering the services: 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

More information

Modifiers. Page 1 of 6

Modifiers. Page 1 of 6 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

More information

Anesthesia Services. UnitedHealthcare Medicare Reimbursement Policy Committee

Anesthesia Services. UnitedHealthcare Medicare Reimbursement Policy Committee 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

More information

Anesthesia Services DESCRIPTION:

Anesthesia Services DESCRIPTION: 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

More information

Billing & Compliance for Anesthesia Services. Charles Whitten, MD Professor and Chairman

Billing & Compliance for Anesthesia Services. Charles Whitten, MD Professor and Chairman 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

More information

OBGYN Orientation & Billing Guide 9/22/2014

OBGYN Orientation & Billing Guide 9/22/2014 OBGYN Orientation & Billing Guide 2014 Welcome to Magnolia Health! We thank you for being part of or considering Magnolia s network of participating providers, hospitals, and other healthcare professionals.

More information

Anesthesia Coding and Compliance. Presented by: Melanie Lafferty June 2015

Anesthesia Coding and Compliance. Presented by: Melanie Lafferty June 2015 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

More information

WELLCARE CLAIM PAYMENT POLICIES

WELLCARE CLAIM PAYMENT POLICIES WellCare and Harmony Health Plan s claim payment policies are based on publicly distributed guidelines from established industry sources such as the Centers for Medicare and Medicaid Services (CMS), the

More information

Anesthesia Billing: 101. Presented by: Medi-Corp, Inc www.medi-corp.com

Anesthesia Billing: 101. Presented by: Medi-Corp, Inc www.medi-corp.com 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

More information

Ten Steps to Coding Anesthesia Services

Ten Steps to Coding Anesthesia Services 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 Disclaimer The information

More information

HCPCS codes should be used to describe outpatient diagnostic laboratory procedures (revenue codes 300 to 319).

HCPCS codes should be used to describe outpatient diagnostic laboratory procedures (revenue codes 300 to 319). 6How Do I Bill Tribal Outpatient Hospital Services? Complete the UB-04 form for outpatient hospital services. Refer to How do I complete the UB-04? in the Billing Guidelines section for specific information

More information

Physician Services. Anesthesia. ARCHIVAL USE ONLY Refer to the Online Handbook for current policy

Physician Services. Anesthesia. ARCHIVAL USE ONLY Refer to the Online Handbook for current policy 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.

More information

professional billing module

professional billing module professional billing module Professional CMS-1500 Billing Module Coding Requirements...2 Evaluation and Management Services...2 Diagnosis...2 Procedures...2 Basic Rules...3 Before You Begin...3 Modifiers...3

More information

Oregon CO-OP Modifier Table - December 2013

Oregon CO-OP Modifier Table - December 2013 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

More information

WHAT YOU NEED TO KNOW. Jay Mesrobian, M.D. John Stephenson, M.D. David Biel, AA C Michael Nichols, AA C

WHAT YOU NEED TO KNOW. Jay Mesrobian, M.D. John Stephenson, M.D. David Biel, AA C Michael Nichols, AA C 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

More information

IWCC 50 ILLINOIS ADMINISTRATIVE CODE 7110 7110.90. Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule

IWCC 50 ILLINOIS ADMINISTRATIVE CODE 7110 7110.90. Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule a) In accordance with Sections 8(a), 8.2 and 16 of the Workers' Compensation Act [820 ILCS 305/8(a), 8.2 and 16] (the Act),

More information

Payment Policy. Evaluation and Management

Payment Policy. Evaluation and Management Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions

More information

Corporate Medical Policy

Corporate Medical Policy File Name: anesthesia_services Origination: 8/2007 Last CAP Review: 1/2016 Next CAP Review: 1/2017 Last Review: 1/2016 Corporate Medical Policy Description of Procedure or Service There are three main

More information

Florida Medicaid. Anesthesia Services Coverage Policy. Agency for Health Care Administration. Draft Rule

Florida Medicaid. Anesthesia Services Coverage Policy. Agency for Health Care Administration. Draft Rule Florida Medicaid Agency for Health Care Administration Draft Rule Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible Recipient... 2

More information

Pulse Complete EHR. Anesthesia Billing. www.pulseinc.com

Pulse Complete EHR. Anesthesia Billing. www.pulseinc.com Pulse Complete EHR Anesthesia Billing www.pulseinc.com About This Document The following document details the features and workflow of Anesthesia Setup available within the Pulse Complete EHR software.

More information

Preface. Summary of Changes. Table of Contents. Service Contacts. November 2014 Replaces: September 2014 S-5787 11/14

Preface. Summary of Changes. Table of Contents. Service Contacts. November 2014 Replaces: September 2014 S-5787 11/14 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

More information

Modifier Usage Guide What Your Practice Needs to Know

Modifier Usage Guide What Your Practice Needs to Know BlueCross BlueShield of Mississippi Modifier Usage Guide What Your Practice Needs to Know Modifier 22 Usage Modifier 22 - Procedural Service The purpose of this modifier is to report services (surgical

More information

Anesthesia Coding and Compliance. Presented by: Melanie Lafferty July 2014

Anesthesia Coding and Compliance. Presented by: Melanie Lafferty July 2014 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

More information

Basics of Anesthesia Reimbursement. Tracy Paul Young CRNA, MSNA, MBA,SRS LOUSIANNA Paul Carpenter CRNA, MS, SRS MISSISSIPPI

Basics of Anesthesia Reimbursement. Tracy Paul Young CRNA, MSNA, MBA,SRS LOUSIANNA Paul Carpenter CRNA, MS, SRS MISSISSIPPI Basics of Anesthesia Reimbursement Tracy Paul Young CRNA, MSNA, MBA,SRS LOUSIANNA Paul Carpenter CRNA, MS, SRS MISSISSIPPI Objectives Identify the difference between Professional Fees and Technical Fees

More information

Florida Medicaid. Anesthesia Services Coverage Policy. Agency for Health Care Administration. Draft Rule

Florida Medicaid. Anesthesia Services Coverage Policy. Agency for Health Care Administration. Draft Rule Florida Medicaid Agency for Health Care Administration Draft Rule Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions.... 1 2.0 Eligible Recipient... 2

More information

WORKERS' COMPENSATION MEDICAL FEE SCHEDULE RULE 40.000

WORKERS' COMPENSATION MEDICAL FEE SCHEDULE RULE 40.000 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

More information

Anesthesiology Billing. How to Ensure Proper Reimbursement and Avoid a RAC Audit

Anesthesiology Billing. How to Ensure Proper Reimbursement and Avoid a RAC Audit 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

More information

CPT/HCPCS Modifiers. [Refer to WAC 182-531-1850(10) and (11)] Italics indicate additional Agency language not found in CPT.

CPT/HCPCS Modifiers. [Refer to WAC 182-531-1850(10) and (11)] Italics indicate additional Agency language not found in CPT. CPT/HCPCS Modifiers [Refer to WAC 182-531-1850(10) and (11)] Italics indicate additional Agency language not found in CPT. 22: Unusual Procedural Services: When the service(s) provided is greater than

More information

Empire BlueCross BlueShield Professional Reimbursement Policy

Empire BlueCross BlueShield Professional Reimbursement Policy 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

More information

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center SECTION 5 HOSPITAL SERVICES Table of Contents 1 GENERAL POLICY... 2 1-1 Clients Enrolled in a Managed Care Plan... 3 1-2 Clients NOT Enrolled in a Managed Care Plan (Fee-for-Service Clients)..................

More information

Guidelines for Core Clinical Privileges Certified Registered Nurse Anesthetists

Guidelines for Core Clinical Privileges Certified Registered Nurse Anesthetists Guidelines for Core Clinical Privileges Certified Registered Nurse Anesthetists Copyright 2005 222 South Prospect Park Ridge, IL 60068 www.aana.com Guidelines for Core Clinical Privileges Certified Registered

More information

There are two levels of modifiers: Level 1 (CPT) and Level II (CMS, also known as HCPCS).

There are two levels of modifiers: Level 1 (CPT) and Level II (CMS, also known as HCPCS). 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

More information

MEDICAL FEES; REIMBURSEMENT LEVELS; REPORTING REQUIREMENTS

MEDICAL FEES; REIMBURSEMENT LEVELS; REPORTING REQUIREMENTS Chapter 5: MEDICAL FEES; REIMBURSEMENT LEVELS; REPORTING REQUIREMENTS SUMMARY: This Chapterchapter outlines billing procedures and reimbursement levels for health care providers who treat injured employees.

More information

MAKING DOLLAR$ AND $ENSE

MAKING DOLLAR$ AND $ENSE MAKING DOLLAR$ 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

More information

MEDICAL POLICY Modifier Guidelines

MEDICAL POLICY Modifier Guidelines 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

More information

Inpatient Services. Guide to Billing Facility Services. November 2013. Preface. Summary of Changes. Table of Contents.

Inpatient Services. Guide to Billing Facility Services. November 2013. Preface. Summary of Changes. Table of Contents. Inpatient Services Preface Summary of Changes Table of Contents Service Contacts November 2013 Replaces: December 2012 S-5781 11/13 Preface The Wellmark Provider Guide and specialty guides are billing

More information

CHAPTER 27 THE SCOPE OF PROFESSIONAL NURSING PRACTICE AND ARNP AND CNM PROTOCOLS

CHAPTER 27 THE SCOPE OF PROFESSIONAL NURSING PRACTICE AND ARNP AND CNM PROTOCOLS I. INTRODUCTION CHAPTER 27 THE SCOPE OF PROFESSIONAL NURSING PRACTICE AND ARNP AND CNM PROTOCOLS Advance registered nurse practitioners (ARNPs) and clinical nurse practitioners (CNPs) have their scope

More information

CALIFORNIA ASSOCIATION OF NURSE ANESTHETISTS CRNA SCOPE OF PRACTICE GUIDELINES

CALIFORNIA ASSOCIATION OF NURSE ANESTHETISTS CRNA SCOPE OF PRACTICE GUIDELINES CALIFORNIA ASSOCIATION OF NURSE ANESTHETISTS CRNA SCOPE OF PRACTICE GUIDELINES The following offers guidance on the scope of practice for Certified Registered Nurse Anesthetists (CRNAs) in California.

More information

Medical Practitioner Reimbursement

Medical Practitioner Reimbursement INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Medical Practitioner Reimbursement 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 6 P U B L I S H E D : F E B R U A R Y 25,

More information

Status Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session.

Status Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session. Status Active Reimbursement Policy Section: Surgery/Interventional Procedure Policy Number: RP - Surgery/Interventional Procedure - 001 Assistant Surgeons Effective Date: June 1, 2015 Assistant Surgeons

More information

ILLINOIS WORKERS' COMPENSATION COMMISSION MEDICAL FEE SCHEDULE INSTRUCTIONS AND GUIDELINES

ILLINOIS WORKERS' COMPENSATION COMMISSION MEDICAL FEE SCHEDULE INSTRUCTIONS AND GUIDELINES 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

More information

Medicare Information for Advanced Practice Nurses and Physician Assistants. September 2010 / ICN: 901623

Medicare Information for Advanced Practice Nurses and Physician Assistants. September 2010 / ICN: 901623 R Medicare Information for Advanced Practice Nurses and Physician Assistants September 2010 / ICN: 901623 This publication provides information about required qualifications, coverage criteria, billing,

More information

Section 2. Licensed Nurse Practitioner

Section 2. Licensed Nurse Practitioner Section 2 Table of Contents 1 General Information... 2 1-1 General Policy... 2 1-2 Fee-For-Service or Managed Care... 2 1-3 Definitions... 2 2 Provider Participation Requirements... 3 2-1 Provider Enrollment...

More information

Provider restrictions apply please see Behavioral Health Policy.

Provider restrictions apply please see Behavioral Health Policy. Payment Policy Mid-Level Practitioner EFFECTIVE DATE: 02 02 2006 POLICY LAST UPDATED: 10 01 2013 OVERVIEW This policy documents the services covered when rendered by a BCBSRI credentialed Mid-level practitioners

More information

The Impact of Regional Anesthesia on Perioperative Outcomes By Dr. David Nelson

The Impact of Regional Anesthesia on Perioperative Outcomes By Dr. David Nelson 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

More information

Physician Fee Schedule BCBSRI follows CMS Physician Fee Schedule (PFS) Relative Value Units (RVU) for details relating to

Physician Fee Schedule BCBSRI follows CMS Physician Fee Schedule (PFS) Relative Value Units (RVU) for details relating to Policy Coding and Guidelines EFFECTIVE DATE: 09 01 2015 POLICY LAST UPDATED: 09 02 2015 OVERVIEW This Policy provides an overview of coding and guidelines as they pertain to claims submitted to Blue Cross

More information

Arkansas Medicaid Physician/Independent Lab/CRNA/Radiation Therapy Center Providers

Arkansas Medicaid Physician/Independent Lab/CRNA/Radiation Therapy Center Providers Arkansas Department of Human Services Division of Medical Services Donaghey Plaza South P.O. Box 1437 Little Rock, Arkansas 72203-1437 Internet Website: www.medicaid.state.ar.us Telephone (501) 682-8292

More information

1) There are 0 indicator edits, which are never correctly reported together;

1) There are 0 indicator edits, which are never correctly reported together; Medical Coverage Policy Coding and Guidelines sad EFFECTIVE DATE: 11/15/2011 POLICY LAST UPDATED: 11/1/2013 OVERVIEW This Policy provides an overview of coding and guidelines as they pertain to claims

More information

Regions Hospital Delineation of Privileges Certified Registered Nurse Anesthetist

Regions Hospital Delineation of Privileges Certified Registered Nurse Anesthetist 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.

More information

Highlights of the Florida Medicaid Ambulatory Surgical Center Services Coverage and Limitations Handbook

Highlights of the Florida Medicaid Ambulatory Surgical Center Services Coverage and Limitations Handbook Highlights of the Florida Medicaid Ambulatory Surgical Center Services Coverage and Limitations Handbook Agency for Health Care Administration July 2013 1 Learning Objectives Provide an overview of the

More information

Scope and Standards for Nurse Anesthesia Practice

Scope and Standards for Nurse Anesthesia Practice 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

More information

Mississippi Medicaid. Provider Reference Guide. For Part 203. Physician Services

Mississippi Medicaid. Provider Reference Guide. For Part 203. Physician Services Mississippi Medicaid Provider Reference Guide For Part 203 Physician Services This is a companion document to the Mississippi Administrative Code Title 23 and must be utilized as a reference only. January

More information

Ambulatory Surgery Center Coding and Payment Guide 2015

Ambulatory Surgery Center Coding and Payment Guide 2015 Targeted Drug Delivery Ambulatory Surgery Center Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party

More information

DEPARTMENT OF SOCIAL SERVICES AUDIT PROTOCOL PHYSICIAN SERVICES UPDATED FEBRUARY 1, 2015

DEPARTMENT OF SOCIAL SERVICES AUDIT PROTOCOL PHYSICIAN SERVICES UPDATED FEBRUARY 1, 2015 DEPARTMENT OF SOCIAL SERVICES AUDIT PROTOCOL PHYSICIAN SERVICES UPDATED FEBRUARY 1, 2015 Listed are the most common audit findings noted for physician services provided under the State Medicaid program,

More information

POLICY and PROCEDURE. TITLE: Documentation Requirements for the Medical Record. TITLE: Documentation Requirements for the Medical Record

POLICY and PROCEDURE. TITLE: Documentation Requirements for the Medical Record. TITLE: Documentation Requirements for the Medical Record POLICY and PROCEDURE TITLE: Documentation Requirements for the Medical Record Number: 13289 Version: 13289.1 Type: Administrative - Medical Staff Author: Joan Siler Effective Date: 8/16/2011 Original Date:

More information

The following instructions are taken directly from the Consultations section of CPT:

The following instructions are taken directly from the Consultations section of CPT: Heading: Clarification Title: Consultations Noridian Administrative Services (NAS) published this article on Consultations in Medicare B News, Issue 222, which was dated September 7, 2005. This article

More information

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER - SHREVEPORT MEDICAL RECORDS CONTENT/DOCUMENTATION

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER - SHREVEPORT MEDICAL RECORDS CONTENT/DOCUMENTATION LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER - SHREVEPORT MEDICAL RECORDS CONTENT/DOCUMENTATION Hospital Policy Manual Purpose: To define the components of the paper and electronic medical record

More information

Preface. Summary of Changes. Table of Contents. Service Contacts. October 2014 Replaces: May 2014 S-5781 10/14

Preface. Summary of Changes. Table of Contents. Service Contacts. October 2014 Replaces: May 2014 S-5781 10/14 Preface Summary of Changes Table of Contents Service Contacts October 2014 Replaces: May 2014 S-5781 10/14 Preface The Wellmark Provider Guide and specialty guides are billing resources for providers doing

More information

UTMB BILLING COMPLIANCE PLAN: DOCUMENTATION AND VERIFICATION FOURTH ADDITION OF THE ANESTHETIC CARE

UTMB BILLING COMPLIANCE PLAN: DOCUMENTATION AND VERIFICATION FOURTH ADDITION OF THE ANESTHETIC CARE 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

More information

THE ORGANIZATION OF AN ANESTHESIA DEPARTMENT

THE ORGANIZATION OF AN ANESTHESIA DEPARTMENT THE ORGANIZATION OF AN ANESTHESIA DEPARTMENT Committee of Origin: Quality Management and Departmental Administration (Approved by the ASA House of Delegates on October 15, 2003, and last amended on October

More information

Center for Medicaid and State Operations/Survey and Certification Group

Center for Medicaid and State Operations/Survey and Certification Group 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

More information

CHAP2-CPTcodes00000-01999_final103115.doc Revision Date: 1/1/2016

CHAP2-CPTcodes00000-01999_final103115.doc Revision Date: 1/1/2016 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

More information

Maternity billing codes

Maternity billing codes Maternity Billing The Maternity Period - For billing purposes, the obstetrical period begins on the date of the initial visit in which pregnancy was confirmed and extends through the end of the postpartum

More information

Scope and Standards for Nurse Anesthesia Practice

Scope and Standards for Nurse Anesthesia Practice 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

More information

CPT Coding in Oral Medicine

CPT Coding in Oral Medicine CPT Coding in Oral Medicine CPT - Current Procedural Terminology Medical Code Set (00000-99999) Established as an indexing/coding system to standardize terminology among physicians and other providers

More information

MARYLAND MEDICAL ASSISTANCE PROGRAM PHYSICIANS SERVICES PROVIDER FEE MANUAL. Effective January 2010

MARYLAND MEDICAL ASSISTANCE PROGRAM PHYSICIANS SERVICES PROVIDER FEE MANUAL. Effective January 2010 COMAR 10.09.02 MARYLAND MEDICAL ASSISTANCE PROGRAM PHYSICIANS SERVICES PROVIDER FEE MANUAL Effective January 2010 Revision 2010 TABLE OF CONTENTS PAGE COMAR 10.09.02 INTRODUCTION 1 GENERAL INFORMATION

More information

NASI Per Diem Malpractice

NASI Per Diem Malpractice Dear Nurse Anesthetist, We appreciate your interest in NASI s Per Diem Malpractice Insurance. This service is for those providers who need a supplemental policy for working an assignment outside of their

More information

100.1 - Payment for Physician Services in Teaching Settings Under the MPFS. 100.1.1 - Evaluation and Management (E/M) Services

100.1 - Payment for Physician Services in Teaching Settings Under the MPFS. 100.1.1 - Evaluation and Management (E/M) Services 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

More information

Physician Coding and Payment Guide 2015

Physician Coding and Payment Guide 2015 Targeted Drug Delivery Physician Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party sources and is subject

More information

ANESTHESIA BILLING CODING revised 6/28/08

ANESTHESIA BILLING CODING revised 6/28/08 ANESTHESIA BILLING CODING revised 6/28/08 Purpose: Provide new FAA members the basic information for coding anesthesia cases and some basic rules for daily practice. The FAA Billing Basics: Anesthesia

More information

The following is a description of the fields that appear on the results page for the Procedure Code Search.

The following is a description of the fields that appear on the results page for the Procedure Code Search. Fee Schedule Legend Updated: 9/21/2015 The following is a description of the fields that appear on the results page for the Procedure Code Search. Procedure Code the five-character procedure code as listed

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: observation_room_services 2/1997 2/2016 2/2017 2/2016 Description of Procedure or Service Observation services

More information