Resource Anesthesia Coding

Anesthesiology coding is a unique specialty within the world of medical coding, and it requires a special skill-set and mastery of both the CPT coding paradigm and the ASA coding system. They must know surgical and obstetric coding rules in addition to the anesthesiology regulations. Add to that the expertise needed to code pain management procedures which encompasses E&M services, radiology, and surgical coding, and you have a very esoteric job description requiring advanced anesthesia coding training, mentoring, hands-on experience, and continuous updating and supervision

Anesthesia

— Anesthesia is a state of temporary induced (Drug/Gas) loss of sensation or awareness. The CPT code range from 00100 – 01999 plus “Anesthesia modifier”.
— An Anesthesiologist, Anesthesia assistant or qualified non-physician anesthetist can provide Anesthesia service.
The anesthesia care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and post-anesthesia recovery care.

Included services
1. Preoperative & Postoperative care
2. Administration of fluids and/or Blood
3. Monitoring services (Eg: BP, Temperature, ECG, Oximetry, Mass Spectrometry, and Capnography)

Excluded services
1. Other Monitoring services like Central venous, Intra-arterial and Swan-Ganz

Types of Anesthesia:

General

• Beneficiary is drug-induced by mask or IV to a loss of consciousness and are not awakened, even by painful stimulation
• Many functions of the body will slow down or need help to work effectively; a tube may be placed to assist the beneficiary with breathing
• Heart rate, blood pressure, breathing and other vital signs are monitored
• Services include:

• Pre/post-operative visits
• Administration of fluids and/or blood
• Usual monitoring service (e.g., temperature, ECG, blood pressure, oximetry, capnography and mass spectrometry)

Regional

• May be performed as a single injection or with a continuous catheter in which medication is given over a prolonged period (includes epidurals, spinals and other central nerve blocks)
• Medication delivered to specific level of the spinal cord and/or peripheral nerves
• Used when loss of consciousness is not desired by a sufficient loss of movement is required

Topical or Local

• Drug application or injection or a combination of drugs
• Stops or prevents painful sensation to specific area
• Not payable by Medicare (bundled into service performed)

(General anesthesia suppresses the CNS, Regional and local anesthesia block transmission of nerve impulses)
Analgesia/Deep Sedation

• Analgesic drugs act in various ways on the peripheral and central nervous systems to give pain relief without losing consciousness
• Patient-controlled analgesia not payable by Medicare
• Airway intervention may be required
• Non-anesthesia physicians can bill if credentialed, properly trained, etc.
• Modifier G8 must be appended: Monitored anesthesia care for deep complex, complicated or markedly invasive surgical procedure

Monitored Anesthesia Care (MAC)

• Drug-induced consciousness with no intervention required to maintain airways; however, cardiovascular is maintained
• Beneficiary oxygenation, ventilation, circulation and temperature should be evaluated. Close monitoring is necessary to anticipate the need for general anesthesia administration or for the treatment of adverse physiologic reactions
• By practitioner qualified to administer anesthesia defined by Code of Federal Regulations 42 CFR 482.52(a)
• Deep sedation/analgesia included in MAC and beneficiary can still respond

Moderate Sedation

• Drug-induced depression of consciousness where beneficiaries become relaxed and insensitive to pain but remain awake and able to respond to verbal instruction
• No interventions are required to maintain airway; Cardiovascular function is usually maintained
• Does not include deep or minimal sedation or MAC
• Physician or a face-to-face supervised specially trained sedation nurse may perform
• Must have independent trained observer, for example, Nurse Practitioner (NP), Physician Assistant (PA), Registered Nurse (RN), whose sole duty is to monitor beneficiary's level of consciousness and physiological status; must be present throughout entire diagnostic or therapeutic service; must be identified in notes with credentials
• Time ends at conclusion of personal contact by physician providing sedation

 

[Lori]

Covered Providers
General, Regional, and Monitored Anesthesia

• Anesthesiologist or MD, DO
• Dentist, oral surgeon or podiatrist qualified to administer under State law
• Certified Registered Nurse Anesthetist (CRNA) who is supervised by operating room practitioner or by anesthesiologist who is immediately available if needed
• Anesthesiologist Assistant (AA) under supervision of anesthesiologist who is immediately available if needed
• Not Covered: Locum tenens not allowed to replace AAs or CRNAs (only MDs); even in rural areas

CRNA

• Must meet all State guidelines and licensure to perform the following:
• Insertion of arterial line
• Swan-Ganz catheter for monitoring purposes
• Central venous line
• Place peripherally inserted central venous catheters (PICC) and central venous pressure (CVP) monitors
• May perform services at hospitals, offices, free standing clinics and Ambulatory Surgical Centers (ASCs)
• May supervise two concurrent cases involving student nurse anesthetists and must be present during pre- and post-anesthesia for both cases
• May bill when providing teaching services for a student; Documentation should show CRNA was continuously present; Append modifier QZ (CRNA service; without medical direction by a physician)
• Modifier QZ is not used by a CRNA when he/she is the non-physician anesthetist with medical direction by a physician, if performing monitored anesthesiology care or there is medical direction of one qualified non-physician anesthetist by an anesthesiologist

Anesthesia “provision/supervision” modifiers (-AA, -QK, -QY, -QZ, -AD and -QX) explain the role of the anesthesiologist and CRNA. These modifiers are essential for clarifying whether an anesthesia procedure was personally performed, medically directed or medically supervised by an anesthesiologist. Knowing what constitutes medical direction is only part of the challenge. State regulations can create another layer of potential confusion. For example, in some states, Certified Registered Nurse Anesthetists (CRNAs) can work independent of a physician’s medical direction, while other states do not allow such practice.

To ensure compliance, practices should take two steps:

1) discuss what they want to achieve in the operating room (OR) from a strategic standpoint, then
2) make sure physicians understand the appropriate medical direction criteria and that it is clearly documented. For example: A practice in a state where CRNAs cannot work independently might decide it wants its anesthesiologists to provide medical direction of only one CRNA, coded with -QY. Another practice might encourage its anesthesiologists to provide medical direction of two to four concurrent anesthesia procedures, coded with modifier -QK.

To support medical direction, CMS 100-4, 12 § 50 (C) states physicians must document that they performed each of seven medical direction functions: performed the pre-anesthesia exam and evaluation; prescribed the anesthesia plan; personally took part in the most demanding procedures in the anesthesia plan, including induction and emergence where indicated; ensured any procedures in the anesthesia plan not performed personally were done by a qualified anesthetist; monitored the course of anesthesia administration frequently; was physically present and immediately available for the diagnosis and treatment of emergencies; and provided indicated post-anesthesia care.
It’s important to note that medical direction applies only if a physician oversees four or fewer procedures. Any more than that, and practices must use medical supervision (modifier -AD), as explained in an American Society of Anesthesiologists (ASA) Timely Topics article.

Distinct procedural modifiers (-59, -XE, -XP, -XS and -XU).
Payers routinely bundle the payment for some services into the payment for other services. Medicare calls these “bundled” services (CMS 100-4, 12 20.3). However, sometimes two procedures normally bundled together really are “separate and distinct” from one another. That’s where modifiers -59, -XE, -XP, -XS and -XU come into play.

To use CPT modifier -59 appropriately, CMS MLN Matters® article number SE1418 states that physicians must document “… a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual.”
However, CMS MLN Matters® article number MM8863 also points out that CPT instructions say modifier -59 should not be used when a more descriptive modifier is available. Although CMS still accepts -59, four more specific “separate procedure” modifiers may be used instead of -59 on Medicare claims. They are: -XE (separate encounter); -XP (separate practitioner); -XS (separate structure); and -XU (unusual non-overlapping service). Some examples of proper use are:

• -XS when two pain injections are performed for two different levels of vertebrae.
• -XU when a pain block for post-op pain is performed in pre-op holding (because the pain block is not the usual component of the anesthesia service being performed the same day).Further examples can be found from Novitas Solutions.

Discontinuous or extended time.
Time is a unique but critical aspect of anesthesia coding. As a result, lots of misinformation surrounds start/stop time and discontinuous time. Here is a little clarity:

• Anesthesia time can begin before you enter the OR. According to CMS 100-4, 12 50 (G), anesthesia time “… starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is, when the patient may be placed safely under postoperative care.”
• Discontinuous time is recognized by Medicare and other payers. Again according to CMS 100-4, 12 50 (G): “Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time for services furnished, the anesthesia practitioner can add blocks of time around an interruption in anesthesia time as long as the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption.” Think of it this way: The idea is to bill for the total concentration and skill of the anesthesiologist.

https://www.abeo.com/three-common-anesthesia-coding-challenges/

 

[Lori]

Global Services

Global reimbursement of anesthesia administration includes the following:

• Pre-anesthesia evaluation [Physicians’ Current Procedural Terminology (CPT) codes 99201-99205, 99221-99223];
• Post-postoperative visits (CPT codes 99211-99215, 99231-99233);
• Anesthetic or analgesic administration;
• Local anesthesia during surgery;
• Monitoring of electrocardiograms (EKGs), pulse breathing, blood pressure, electroencephalogram and other neurological monitoring;
• Monitoring of left ventricular or valve function via transesophageal echocardiogram (TEE);
• Monitoring of intravascular fluids (IVs), blood administration and fluids used during cold cardioplegia through non-invasive means; and
• Maintenance of open airway and ventilator measurements and monitoring.

Arterial lines and monitoring are no longer included in the global anesthesia fee. Bill for these services separately using the same major/minor guidelines that are used with surgical services, when billed with other procedures such as Swan Ganz.

Use of TEE for routine monitoring of patients undergoing cardiac and non-cardiac surgery does not meet Blue Cross’ medical criteria for coverage. See Medical Policy #269: Intraoperative Transesophageal Echocardiography for additional details and covered indications.

According to CPT guidelines, the reporting of anesthesia services is appropriate by or under the responsible supervision of a physician. These services may include, but are not limited to, general, regional and supplementation of local anesthesia or other supportive services in order to provide the patient with optimal anesthesia care during any procedure.

Medical Direction
Medical direction occurs when an anesthesiologist is involved in two, three or four concurrent anesthesia procedures or a single anesthesia procedure with a qualified anesthetist. Payment will be determined for the physician’s medical direction service of the allowable charge for the physician personally performing the anesthesia services. For each anesthesia procedure, the anesthesiologist must provide the following seven services and record each in the patient’s anesthesia record:

1. A pre-anesthetic examination and evaluation;
2. Prescribe the anesthesia plan;
3. Personally participate in the most demanding procedures of the anesthesia plan including, if applicable, induction and emergence;
4. Ensure that any procedure in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist;
5. Monitor the course of anesthesia administration at frequent intervals;
6. Remain immediately physically present and available for immediate diagnosis and treatment of emergencies; and
7. Provide the indicated post-anesthesia care.

When the anesthesiologist does not fulfill all of the “medical direction” requirements listed above, the concurrent anesthesia services are considered medical supervision services, not medical direction services.

• When an anesthesiologist is supervising more than four concurrent cases, the service should be filed as follows: anesthesiologist – “AD” and CRNA – “QX”
• When a CRNA personally performed the services without medical direction or supervision, as described above, the service should be filed as follows: CRNA – “QZ”
• AAs are always under the “medical direction” of an anesthesiologist
Ordinarily, an anesthesiologist should not furnish additional services to other patients while concurrently directing the administration of anesthesia. Benefits may be provided if the anesthesiologist provides any of the following services to other patients while medically directing the administration of anesthesia without affecting their ability to administer medical direction:
• Addressing an emergency of short duration in the immediate area, such as:

1. Labor epidural placement and management;
2. Responding to medical emergencies or urgencies of short duration (i.e., establishing intravascular access in patient whose quality of care is reduced without it, tracheal intubation, advanced circulatory life support (ACLS) provision, etc.);

• Administering an epidural or caudal anesthetic to ease labor pain;
• Administering an epidural steroid injection or trigger point injection requested by another physician.

The epidural or trigger point injection may only be done in compliance with the 1:4 ratio. This does not include consults to diagnose and treat. The intent of allowing this practice is enhancement of efficiency in providing these comonly requested procedures. The intent is not to allow or encourage anesthesiologists to schedule and provide a full service chronic pain management clinic while also concurrently attempting to provide the care to patients receiving surgical anesthesia under his or her direction. The consult for performance of an epidural or trigger point may serve as the second, third, or fourth concurrent case. This means that performing limited pain services is not allowed while medically directing four concurrent anesthetics. The anesthesiologist involved is responsible for being sure his or her ability to respond to urgent or emergent needs in operating rooms, labor and delivery rooms, or any other place in the hospital where responsibility may be, is not unsafely reduced at any time;

• Periodic rather than continuous monitoring of an obstetrical patient;
• Receiving patients entering the operating suite for the next surgery;
• Checking on or discharging patients from the post anesthesia care unit; and/or
• Coordinating scheduling matters.

Personally Performed Anesthesia Determined by the following:

• Anesthesiologist personally performed the entire anesthesia service alone;
• Anesthesiologist is continuously involved in a single case involving a student nurse anesthetist; or
• Anesthesiologist and the CRNA are involved in one anesthesia case, and the service of each are found to be medically necessary upon appeal.

Documentation must be submitted by both practitioners to support payment;

• CRNA personally performed the entire anesthesia service alone without:
1. Medical direction by anesthesiologist, and;
2. Not medically supervised by an anesthesiologist.

Qualifying Circumstances Qualifying circumstances are those factors such as extreme age, extraordinary condition of the patient, and unusual risk factors which may affect the anesthesia services. These procedures are considered add-on codes and would not be reported alone, but as additional procedures qualifying an anesthesia procedure or service. These procedures must be filed with the appropriate modifier. Codes without the appropriate modifier may be returned or rejected. Do not bill these procedures with physical status modifiers or anesthesia minutes.

An additional fee will be reimbursed based on the allowed units for each circumstance:

99100 – Anesthesia for Patient of Extreme Age, Under 1 Year and Over 70 – 1 unit
99116 – Anesthesia Complicated By Utilization of Total Body Hypothermia – 5 units
99135 – Anesthesia Complicated By Utilization of Controlled Hypotension – 5 units
99140 – Anesthesia Complicated – 1 unit

Additional Anesthesia Modifiers The following modifiers should be used as secondary or tertiary modifiers only and not as the primary modifier. These modifiers are intended to provide additional information specific to the services provided; there will be no additional reimbursement made for these modifiers.

Multiple Anesthesiologists

When multiple anesthesiologists provide services, the anesthesiologist who either started the case or who spent the most time with the beneficiary providing services will submit a claim for the entire case. The time for all anesthesia procedures must be combined and be sure the documentation contains all physicians involved.
When a teaching facility is involved, only the physician who started the case may submit a claim.

Provider Interaction
Medical Direction

Medical direction is a billing distinction describing a higher level of physician involvement in a case than medical supervision. To bill for medical direction, the physician would medically direct qualified providers (e.g., CRNAs, AAs, interns, residents or combinations of these individuals) in two, three or four concurrent cases and perform the following:

1. Pre-anesthetic exam and evaluation;

1. Prescribes anesthesia plan;

1. Personally participates in anesthesia procedures; including induction and emergence;

1. Ensures procedures in anesthesia plan that he/she does not perform are performed by qualified anesthetist;

1. Monitors course of anesthesia frequently;

1. Remains physically present and available for immediate diagnosis and treatment of emergencies; and

1. Provides any indicated post-anesthesia care.

Medical Supervision

Medical supervision occurs when the anesthesiologist is involved in more than four concurrent cases and when not all seven services under medical direction are performed.

Teaching

Teaching occurs when the anesthesiologist is training resident in up to two concurrent cases or training a resident in one case, while medically directing in another case. Medicare may reimburse an anesthesiologist when providing teaching services.
The anesthesiologist documents his/her presence during the key and critical portions of the service and append modifier GC (service performed in part by a resident under direction of a teaching physician) following the anesthesia modifier. A physician's presence during only the pre- and post-operative care is not sufficient to receive Medicare payment. The teaching physician must be immediately available if needed to furnish anesthesia during the entire procedure.

 

[Lori]

Cancelled Anesthesia

If anesthesia is cancelled due to unforeseen circumstances; the pre-anesthetic examination and the anesthesia services furnished may be billed and paid depending on when the anesthesia services were terminated and whether or not the procedure is rescheduled.

• If a case was cancelled after the pre-operative examination but prior to the patient being prepared for surgery or induction, the service may be covered at the E/M level of care rendered (e.g., brief or limited visit) as a hospital or office visit.
• A pre-anesthesia evaluation by the anesthesiologist when the procedure is delayed less than 30-days is not eligible for coverage as a separate procedure. It is an integral part of the subsequent anesthesia services.
• If a case was cancelled after induction of anesthesia, bill the case with the anesthesia CPT code for the procedure that was being rendered. Add a “53” for the tertiary modifier to indicate the discontinued procedure. Reimbursement will be based on the amount of time reported plus the base units for the discontinued procedure.

Multiple or Duplicate Anesthesia Services

When multiple surgical procedures are performed during a single anesthesia administration, only the anesthesia with the highest base value is reported. Reported time is the combined total for all procedures.
When duplicate anesthesia codes are reported by the same or different provider for the same patient on the same date of service, specific reimbursement will be based on the reported modifier. File with appropriate modifiers.

Labor Epidurals Anesthesia for labor epidurals are time-based services and should be billed as total minutes. CPT code 01967: Neuraxial Labor Analgesia/Anesthesia for Planned Vaginal Delivery This includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor.) Code may be reported as a single anesthesia service.
CPT code 01968: Cesarean delivery following failed attempt at vaginal delivery This is an add-on code and should always be reported with CPT code 01967.
CPT code 01969: Cesarean delivery followed by a cesarean hysterectomy after failed planned vaginal delivery This is an add-on code and should always be reported with CPT code 01967.
CPT code 99140: This add-on code may be billed for labor ending in an urgent or emergency cesarean delivery with four additional units.
Note: 01967 and add-on codes 01968 and 01969 require a concurrency modifier in the first position.

Scenarios:
• For labor less than 4 hours ending in vaginal delivery : CPT code 01967 • For labor less than 4 hours ending in a cesarean delivery: CPT code 01967 and 01968
• For labor ending in an urgent or emergency cesarean delivery, CPT code 99140 may be billed with CPT code 01967 and 01968
• For labor 4 hours or more ending in a vaginal delivery: CPT code 01967 with modifier 23
• For labor 4 hours or more ending in a cesarean delivery : CPT code 01967 with modifier 23 and add on CPT code 01968
• For labor ending in an urgent or emergency cesarean delivery: CPT code 01967 with add-on code 01968 and 99140 Note: Payment for anesthesia administered by the delivering physician is included in the global maternity fee

 

[Lori]

Anesthesia CPT Code Ranges

Area of the Body	CPT Code Range
Head	00100-00222
Neck	00300-00352
Thorax (chest wall and shoulder girdle)	00400-00474
Intrathoracic	00500-00580
Spine and Spinal Cord	00600-00670
Upper Abdomen	00700-00797
Lower Abdomen	00800-00882
Perineum	00902-00952
Pelvis (except hip)	01112-01173
Upper Leg (except knee)	01200-01274
Knee and Popliteal Area	01320-01444
Lower Leg (below knee, including ankle and foot)	01462-01522
Shoulder and Axilla	01610-01680
Upper Arm and Elbow	01710-01782
Forearm, Wrist and Hand	01810-01860
Radiological Procedure	01916-01936
Burn Excisions or Debridement	01951-01953
Obstetric	01958-01969
Other Procedure	01990-01999

Bundled Services
Description	CPT Code
Special anesthesia service	99100
Anesthesia with hypothermia	99116
Special anesthesia procedure	99135
Emergency anesthesia	99140

 

[Lori]

Anesthesia CPT Codes

Head

00100 salivary gland
00102 repair of cleft lip
00103 blepharoplasty
00104 electroshock
00120 ear surgery
00124 ear exam
00126 tympanotomy
00140 procedures on eye
00142 lens surgery
00144 corneal transplant
00145 vitreoretinal surgery
00147 iridectomy
00148 eye exam
00160 nose/sinus surgery
00162 radical nose/sinus surgery
00164 biopsy of nose
00170 intraoral surgery
00172 cleft palate repair
00174 pharyngeal surgery
00176 radical intraoral surgery
00190 face/skull bone surgery
00192 radical facial bone/skull surgery
00210 cranial surgery
00211 cran surg, hemotoma
00212 skull drainage
00214 skull drainage
00215 skull repair/fract
00216 head vessel surgery
00218 intracranial procedures in sitting position
00220 cerebrospinal fluid shunting procedures
00222 intracranial nerve surgery

Neck

00300 head/neck/ptrunk
00320 neck organ, 1 & over 0
00322 biopsy of thyroid 0
00326 larynx/trach, < 1 yr
00350 neck vessel surgery
00352 simple ligation neck vessel

Thorax

00400 skin, ext/per/atrunk
00500 esophageal surgery
00520 closed chest procedures
00522 chest lining biopsy
00524 chest drainage
00528 chest partition view w/o 1 lung vent
00529 chest partition w/ 1 lung vent
00530 pacemaker insertion
00532 vascular access
00534 cardioverter/defib
00537 cardiac electrophys
00539 trach-bronch reconst
00540 chest surgery
00541 chest surgery utilizing one lung vent
00542 release of lung
00546 lung, chest wall surgery
00548 trachea, bronchi surgery
00550 sternal debridement
00560 heart surgery w/o pump
00561 heart surgery w/ pump < age 1
00562 anesth heart surgery w/pmp age 1+
00563 heart surgery w/arrest
00566 cabg w/o pump
00567 cabg w/pump
00580 heart/lung transplant
Intrathoracic
00500 esophageal surgery
00520 closed chest procedures
00522 chest lining biopsy
00524 chest drainage
00528 chest partition view w/o 1 lung vent
00529 chest partition w/ 1 lung vent
00530 pacemaker insertion
00532 vascular access
00534 cardioverter/defib
00537 cardiac electrophys
00539 trach-bronch reconst
00540 chest surgery
00541 one lung ventilation
00542 release of lung?
00546 lung,chest wall surg
00548 trachea,bronchi surg?
00550 sternal debridement
00560 heart surg w/o pump
00561 heart surgery w/ pump < age 1
00562 anesth hrt surg w/pmp age 1+
00563 heart Surg W/Arrest
00566 cabg w/o pump
00567 cabg w/pump
00580 heart/lung transplant
Spine/Spinal Cord
00600 cervical spine, cord surgery
00604 cervical spine and cord surgery in sitting position
00620 thoracic spine, cord surgery
00625 thoracic spine, cord surgery transthoracic w/o 1 lung vent
00626 thoracic spine, cord surgery transthoracic w/ 1 lung vent
00630 lumbar spine, cord surgery
00632 removal of nerves
00635 lumbar puncture
00640 spine manipulation or closed procedures on spine
00670 extensive spine, cord surgery

Upper Abdomen

00700 upper anterior abdominal wall surgery
00702 percutaneous liver biopsy
00730 upper posterior abdominal wall surgery
00731 anesthesia for upper gi endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified
00732 ERCP
00750 repair of hernia
00752 repair lumbar and ventral hernia
00754 omphalocele
00756 transabdominal repair diaphragmatic hernia
00770 blood vessel repair
00790 surgery upper abdomen
00792 hemorr/excise liver
00794 pancreas removal
00796 for liver transplant 0
00797 surgery for obesity

Lower Abdomen

00800 lower anterior abdominal surgery
00802 fat layer removal
00811 anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified
00812 screening colonoscopy
00813 anesthesia for combined upper and lower gi endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum
00820 lower posterior abdominal surgery
00830 repair of hernia
00832 repair ventral and incisional hernia
00834 hernia repair< 1 yr 00836 anesth hernia repair preemie
00840 surgery lower abdomen
00842 amniocentesis
00844 pelvis surgery
00846 radical hysterectomy
00848 pelvic organ surgery
00851 tubal ligation
00860 surgery of abdomen
00862 kidney/ureter surgery
00864 removal of bladder
00865 removal of prostate
00866 removal of adrenal
00868 kidney transplant
00870 bladder stone surgery
00872 kidney stone destruction w/ water bath
00873 kidney stone destruction w/o water bath
00880 abdomen vessel surgery
00882 major vein ligation

Perenium

00902 anorectal
00904 radical perineal surgery
00906 removal of vulva
00908 removal of prostate
00910 bladder surgery
00912 bladder tumor surgery
00914 removal of prostate
00916 bleeding control
00918 stone removal
00920 male genitalia surgery
00921 vasectomy
00922 sperm duct surgery
00924 testis exploration
00926 radical orchiectomy, inguinal
00928 radical orchiectomy, abdominal
00930 testis suspension
00932 amputation of penis
00934 penis, nodes removal
00936 penis, nodes removal
00938 insert penis device
00940 vaginal procedures
00942 surgery on vag/urethral
00944 vaginal hysterectomy
00948 repair of cervix
00950 vaginal endoscopy
00952 hysteroscope/graph

Pelvis

01112 bone aspirate/bx
01120 pelvis surgery
01130 body cast procedure
01140 amputation at pelvis 0
01150 pelvic tumor surgery
01160 closed pelvis procedure
01170 open pelvis surgery
01173 fx repair, pelvis

Upper Leg

01200 closed hip joint procedure
01202 arthroscopy of hip
01210 open hip joint surgery
01212 hip disarticulation
01214 hip arthroplasty
01215 revise hip repair
01220 closed femur procedure, upper 2/3
01230 surgery of femur upper 2/3
01232 amputation of femur
01234 radical femur surgery
01250 procedures on nerve, muscles, tendon, fascia and bursae of upper leg
01260 all procedures on veins of upper leg
01270 all procedures on arteries of upper leg
01272 artery ligation
01274 artery embolectomy

Knee

01320 procedures on nerves, muscles, tendons, fascia, and bursae of knee and/or popliteal area 01340 closed procedures on femur, lower 1/3
01360 open surgery on femur lower 1/3
01380 knee joint procedure
01382 dx knee arthroscopy
01390 closed procedure upper ends tibia, fibula and/or patella
01392 open surgery on upper ends of tibia, fibula, and/or patella
01400 arthroscopic knee joint surgery
01402 knee arthroplasty
01404 amputation at knee
01420 knee joint casting
01430 knee veins surgery
01432 knee vessel surgery
01440 knee arteries surgery
01442 knee artery surgery
01444 knee artery repair

Leg/Ankle/Foot

01462 closed procedure on lower leg, ankle, foot
01464 ankle/ft arthroscopy
01470 procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, foot
01472 achilles tendon surgery
01474 lower leg surgery
01480 open procedures on bones of lower leg, ankle, foot
01482 radical leg surgery
01484 lower leg revision
01486 ankle replacement
01490 lower leg casting
01500 leg arteries surgery
01502 lower leg embolectomy
01520 lower leg vein surgery
01522 lower leg thrombectomy

Shoulder/Axilla

01610 procedures on nerves, muscles, tendons, fascia, and bursae of shoulder and axilla
01620 closed procedure on shoulder
01622 anes dx shoulder arthro
01630 open or surgical arthroscopic procedures on shoulder joint
01634 shoulder disarticulation
01636 forequarter amput
01638 shoulder replacement
01650 shoulder artery surgery
01652 shoulder vessel surgery
01654 shoulder vessel surgery
01656 arm-leg vessel surgery
01670 shoulder vein surgery
01680 shoulder casting

Upper Arm/ Elbow

01710 procedures on nerves muscles, tendons, fascia, and bursae of upper arm and elbow
01712 upper arm tendon surgery
01714 upper arm tendon surgery
01716 biceps tendon repair
01730 closed procedures on humerus and elbow
01732 dx elbow arthroscopy
01740 open or arthroscopic procedures on elbow
01742 humerus surgery
01744 humerus repair
01756 radical humerus surgery
01758 humeral lesion surgery
01760 elbow replacement
01770 upper arm artery surgery
01772 upper arm embolectomy
01780 upper arm vein surgery
01782 upper arm vein repair

Arm/Wrist/Hand

01810 procedures on nerves, muscles, tendons, fascia and bursae of forearm, wrist and hand
01820 closed procedure on radius, ulna, wrist or hand bones
01829 dx wrist arthroscopy
01830 open or surgical arthroscopic procedure on distal radius, distal ulna, wrist, or hand joints
01832 total wrist replacement
01840 lower arm artery surgery
01842 lower arm embolectomy
01844 vascular shunt surgery
01850 lower arm vein surgery
01852 lower arm vein repair
01860 lower arm casting

Radiological Procedure

01916 dx arteriography
01920 catheterize heart
01922 cat or MRI scan
01924 anes, ther interven rad, art
01925 anes, ther interven rad, carotid
01926 anes, ther interven rad, hrt/cran arterv
01930 anes, ther interven rad, vei
01931 anes, ther interven rad, tip
01932 anes, ther interven rad, thoracic vein
01933 anes, ther interven rad, cran vein
01935 percutaneous image dx procedure spine and spinal cord
01936 percutaneous image therapeutic spine and spinal cord

Burns

01951 burn, less 4 percent
01952 burn, 4-9 percent
01953 each additional 9%

Obsteric

01958 antepartum manipul
01960 vaginal delivery
01961 cs delivery
01962 emer hysterectomy
01963 cesarean hysterectomy without any labor analgesia/anesthesia care
01965 incomplete or missed abortion
01966 induced abortion
01967 neuraxial labor analgesia/anesthesia for planned vaginal delivery
01968 cesarean delivery following neuraxial labor analgesia/anesthesia
01969 cesarean hysterectomy following neuraxial labor analgesia/anesthesia

Other Procedures

01990 physiological support for harvesting of organ(s) from brain-dead patient
01991 nerve block/inj
01992 n block/inj, prone
01996 daily hospital management of epidural or subarachnoid continuous drug administration
01999 unlisted anesth procedure

 

[Lori]

Modifiers

For a listing of anesthesia modifiers and descriptions, see the Modifiers webpage. Some modifiers affect payment (list is not all-inclusive).

Description	Modifier
Healthy individual with minimal anesthesia risk.	P1
Mild systemic disease.	P2
Severe systemic disease with intermittent threat of morbidity or mortality.	P3
Severe systemic illness with ongoing threat of morbidity or mortality.	P4
Pre-morbid condition with high risk of demise unless procedural intervention is performed.	P5

Physician status (P1-P6) – not recognized by Medicare

Eg: A patient has hypertension. Append modifier P2 (Systemic disease is not stated as uncontrolled)
A patient has uncontrolled DM – Append modifier P3 (Due to the severe systemic disease)
A patient met with an accident and is dead on arrival to the hospital – Append modifier P6 (is an organ donor)
Billing Guidelines: Except Medicare all other insurance allow physical status modifiers to receive additional total units of anesthesia service reported for patients.

Modifier PT is recognized when billed with 10000-69999 (procedure codes), G0500 and 99153 (moderate sedation) and effective January 1, 2018, anesthesia code 00811 only. Modifier 33 is only recognized with Advance Care Planning (ACP) codes 99497-99498.
Bundled (Never Bill Medicare or Beneficiary)

• Never covered and Advance Beneficiary Notice of Noncoverage (ABN) not allowed: IV starts, Q pain pump, blood gas monitoring and intubation
• Not separately payable: Drugs, supplies or materials

Discontinued Anesthesia
If a beneficiary has been given anesthesia and the surgeon cancels the surgery (e.g., issue with leaking water on floor in operating room), the code would be allowed based on time.
Anesthesia Overlaps Days
If a surgery and anesthesia overlap days, follow this billing example:

• Surgery begins at 11:15 p.m. on February 10
• Surgery ends at 1 a.m. on February 11
• Do not use date span
• Bill with start date and total number of minutes

Anesthesia Not Covered

Anesthesia is not covered if the procedure is not covered (e.g., cosmetic surgery).
Anesthetic drugs such as Lidocaine and Marcaine, etc., when administered for chronic pain are not covered.
Part A
If anesthesia is provided in the inpatient hospital or Ambulatory Surgical Center (ASC), reimbursement is provided by Part A Medicare.
Multiple Procedures
A physician bills for the anesthesia services associated with multiple bilateral surgeries by reporting the anesthesia procedure with the highest base unit value. The total time for all procedures is reported in the line item with the highest base unit value.
If the same anesthesia CPT code applies to two or more of the surgical procedures, billers enter the anesthesia code and the number of surgeries to which the modified CPT code applies.
Payment can be made under the fee schedule for anesthesia services associated with multiple surgical procedures or multiple bilateral procedures. Payment is determined based on the base unit of the anesthesia procedure with the highest base unit value and time units based on the actual anesthesia time of the multiple procedures.
Noridian automatically adds modifier 51, when applicable.
Endoscopy and Teaching Physician
If a beneficiary has Esophagogastroduodenoscopy (EGD) and a screening colonoscopy on the same day, Medicare will pay based on endoscopy rules and multiple procedure rules. Both records should be fully documented. To bill Medicare for endoscopic procedures, the teaching physician must be present during the entire viewing (starts at time of insertion of the endoscope and ends at time of removal of the endoscope). Viewing of the entire procedure through a monitor in another room does not meet the teaching physician presence requirement. In most instances, the EGD will use the anesthesia CPT 00813 for the same day.

Documentation
Medical records should include:

• Clear indication of beneficiary name, date of birth and date of service
• Must support diagnoses code billed
• Pre-anesthetic exam and evaluation
• Detailed exam with pain history and symptoms severity
• Intra-operative report with anesthesia time (beginning of services, any time spent away from beneficiary and discontinuance of services)
• Complete operative report
• Post anesthesia report
• Imaging reports
• Activities of Daily Living (ADLs)
• Conservative treatment such as outpatient therapies or medications
• What or when does beneficiary feel better or worse

Clearly show number of concurrent services supervised by physician or CRNA

 

[Lori]

Anesthesia Base Unit:
Base units are assigned to anesthesia CPT codes by the CMS. Base units are determined based on complexity of the procedures. Easier the case it’s less base unit and difficult cases have the high base unit.
For a complete list with base units’ details: http://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center.html?redirect=/center/anesth.asp

Multiple procedures at the same session:
If multiple surgical procedures are performed during a single anesthesia administration, then only the highest base unit value CPT code should be reported. But the total time spent for all procedures would be considered for Anesthesia Time unit.

Anesthesia Time Unit:
1. Start Time: The anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room. (Note: reviewing Medical Record before surgery is not considered)
2. End Time: The anesthesiologist is no longer in personal attendance; the patient may be safely placed under postoperative supervision.

Time of anesthesia is calculated in units (Each 15 min = 1 unit)
Total anesthesia time should be recorded in minutes. Each 15 min is equal to one unit
Eg: A 45 minutes procedure (From start to finish) it is 3 units of anesthesia time. Do not round up or down the total time. (Total procedure time divided by 15)
Eg: For a 63-minute procedure, it is 4.2 time units
For a 79 minute procedure, it is 5.3 time units
Note: For certain insurance there may be round up or round down concepts applicable, anything below 7.5 minutes round down and above 8 min round up.
For Eg: 39 min should be considered as 3 units (15+15+9). And 37 min should be considered as 2 units (15+15+7).



Discontinuous Time
There may be some interruptions in anesthesia care during a procedure; if the provider is no longer personally attending the patient should be recorded correctly about the interrupted timings.
Eg: The anesthesiologist begins care at 9.00, care interrupted at 9.25 (25 minutes) and resumes care at 9.30 ending care at 9.55 (25 minutes), there would be 50 minutes of anesthesia time. This would be 3.3 Time units.
Conversion Factor:
CMS releases annually and is specific to the locality where the anesthesia service is rendered

The anesthesia conversion factors: http://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center.html

 

[Lori]

Qualifying Circumstances:
Many anesthesia services are provided under complicated circumstances, depending on the risk factors there are few Qualifying circumstances add on codes are coded along with anesthesia procedures in order to get a higher payment.
+99100 Anesthesia for a patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure) is 1 unit of anesthesia.
(Some exceptions are 00326, 00561, 00834, 00836 procedures performed on infants younger than 1 year of age at the time of surgery).
+99116 Anesthesia complicated by utilization of total body hypothermia (List separately in addition to code for primary anesthesia procedure)
+99135 Anesthesia complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure)
+99140 Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure)

Important Abbreviations:
CRNA: Certified registered nurse anesthelogist
SRNA: Student registered nurse anesthetist
MAC: Monitored anesthesia care

https://www.optum360coding.com/upload/pdf/ACC14/ACC14.pdf

• Patients with potential for difficult intubation and/or ventilation with a mask or who are at risk for airway obstruction, including but not limited to: – Patients with previous problems with anesthesia or sedation – Patients with a history of stridor or tracheal stenosis
– Patients with a diagnosis of clinically significant sleep apnea
– Morbidly obese patients
– Patients with dysmorphic facial features, such as Pierre-Robin syndrome, trisomy 21, or Turner’s syndrome
– Patients with oral abnormalities, such as a small opening (<3 cm in an adult), macroglossia, tonsillar hypertrophy, or a nonvisible uvula
– Patients with neck abnormalities, such as limited neck extension, decreased hyoid mental distance (<3 cm in an adult), neck mass, oral or glottic tumors, previous head and neck surgery or radiation, unstable cervical spine, tracheal deviation due to mass or previous surgery, ankylosed cervical spine or advanced rheumatoid arthritis
– Patients with IX or X cranial nerve impairment
– Patients with spinal cord instability
– Patients with jaw abnormalities such as micrognathia, retrognathia, trismus, or significant malocclusion
• Patients with allergies to sedation and analgesia agents
• Alcohol or drug addicted patients or patients with increased tolerance to sedation and analgesic agents such as patients with a chronic pain syndrome
• Patients with increased risk for aspiration (e.g., diabetics with autonomic neuropathy and gastroparesis, achalasia, ascites, swallowing disorders, or bulbar neurologic disorders)
Patients with chronic degenerative neurologic diseases which may cause difficulty swallowing or pose a risk for muscle weakness and respiratory failure (e.g., multiple sclerosis, myasthenia gravis, Parkinson’s disease, amyotrophic lateral sclerosis, etc.)
• Extremes of age (> 70 years of age) • Patients age 18 and under
• Patients who are pregnant
• Combative or uncooperative patients (e.g., pediatric patients)
• Patients with neurobehavioral delays when rapid onset of sedation is a safety concern
• Patients with a history of severe nausea and/or vomiting after administration of sedation with narcotics and/or benzodiazepines
• Patients undergoing prolonged or complex diagnostic or therapeutic procedures such as endoscopic retrograde cholangiopancreatography (ERCP)
• Class III ASA patients when respiratory and/or cardiac complications are a concern
• Class IV ASA patients with a severe systemic disease that limits activity and is a constant threat to life such as:
– Myocardial infarction within last six months
– Stroke within last six months
– Unstable angina
– Severe congestive heart failure
– Severe chronic obstructive pulmonary disease
– Hepatic failure
– Renal failure
– Uncontrolled epilepsy

Anesthesia and Pain Management
Anesthesia is the administration of a drug or gas to induce partial or complete loss of consciousness. Services involving administration of anesthesia should be reported by the use of the CPT anesthesia five-digit procedure code plus modifier codes. Surgery codes are not appropriate unless the anesthesiologist or qualified non-physician anesthetist is performing the surgical procedure.
II. High Risk Indications

• Acute septicemia
• Diabetes, with glucose level greater than 300
• Severe metabolic disorders (e.g., thyrotoxicosis, adrenal gland disorders)
• Electrolyte imbalance (sodium, potassium, and calcium levels outside normal limits)
• Morbid obesity (BMI greater than 40 or BMI greater than 35 with comorbid medical conditions (refractory hypertension, obstructive sleep apnea, coronary heart disease, type 2 diabetes)
• Organic brain syndrome/dementia (with confusion, combative behavior and various types of psychoses)
• Severe anxiety, hysteria, panic attacks for which the patient has received treatment and that cannot be easily controlled with appropriate medications (e.g., anxiolytics)
• Phobic disorders
• Various types of drug dependency or drug abuse (acute detoxification state)
• Alcohol abuse (current, continuous or episodic)
• Intracranial abscess
• Alzheimer's disease
• Seizure disorders (on appropriate anti-epileptic medication)
• Rheumatic fever with cardiac involvement
• Valvular heart disease or disorders
• Malignant hypertension, greater than 110 diastolic or greater than 180 systolic and on two or more hypertensive medications)
• Hypertensive heart disease (patient is acute, unstable and on multiple medications)
• Hypertensive heart and renal disease
• Acute myocardial infarction
• Other forms of acute and subacute forms of ischemic heart disease
• Angina pectoris
• Other forms of chronic ischemic heart disease
• Acute and chronic pulmonary disease (severe)
• Other forms of heart disease such as pericarditis, endocarditis, myocarditis, or cardiomyopathy
• Life threatening arrhythmias (e.g., tachycardia, ventricular fibrilation)
• Heart failure
• Acute cerebrovascular disease
• COPD and allied conditions
• Pneumoconioses or asbestosis
• Respiratory conditions due to chemical fumes and vapors and other external causes (e.g., radiation)
• Pneumothorax
• Pulmonary collapse, emphysema, edema, eosinophyilia or insufficiency
• Hepatic failure, with bilirubin greater than 3
• Massive gastrointestinal bleeding, greater than 500cc blood loss by history
• Renal failure, acute or end-stage renal disease, or on dialysis, with creatinine greater than 2
• Active hallucinations
• Convulsions (unstable patient on multiple medications)
• Hypotension or shock, with systolic pressure greater than 90
• Danger of airway compromise

• History of sleep apnea or stridor; or
• Persons with dysmorphic facial features, such as Pierre-Robin syndrome or Down syndrome; or
• Persons with oral abnormalities, such as small opening (less than 3 cm in adult); protruding incisors; high arched palate; macroglossia; tonsillar hypertrophy; or a poorly visualized or non-visible uvula; or
• Persons with neck abnormalities, such as obesity involving the neck and facial structures, short neck, limited neck extension, spinal cord instability, decreased hyoid-mental distance (less than 3 cm in adult), neck mass, cervical spine disease or trauma, disorders of cranial nerves IX or X, tracheal deviation, or advanced rheumatoid arthritis; or
• Persons with jaw abnormalities, such as micrognathia, retrognathia, trismus, or significant malocclusion; or

• Severe allergic reactions
• Patients with very low pain thresholds with a history of inability to complete endoscopic or other procedures
• Pediatric patients through age 11
• Tracheostomy
• Combative patients (include the appropriate diagnosis of psychosis or drug induced behavior)

https://www.abeo.com/wp-content/uploads/2016/02/15-ICD10_SpecialtyTips_Anesthesiology.pdf

 

[Lori]

https://www.uhcprovider.com/content...es/index/oxford/anesthesia-ces-ohp-010120.pdf

Resources

Access the below anesthesia and pain management related information from this page.

• Anesthesia Types
• Covered Providers
• Provider Interaction
• Reimbursement
• Billing
• Anesthesia and Colonoscopy
• Documentation
• Resources

• https://www.cms.gov/Medicare/Coverage/DeterminationProcess/LCDs
• Facet Joint Injections, Medial Branch Blocks and Facet Joint Radiofrequency Neurotomy
• Monitored Anesthesia Care (MAC) retired April 9, 2018
• Nerve Blockade for Treatment of Chronic Pain and Neuropathy
• Spinal Cord Stimulators for Chronic Pain
• Trigger Point Injections
• http://www.asahq.org/resources
• Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia
• Distinguishing "MAC" from Moderate Sedation/Analgesia (Conscious Sedation)
• Position on MAC
• https://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center
• https://www.cms.gov/Outreach-and-Ed...-MLN/MLNMattersArticles/Downloads/MM10075.pdf
• https://www.cms.gov/Outreach-and-Ed...-MLN/MLNMattersArticles/Downloads/MM10181.pdf
• https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ncd103c1_Part1.pdf
• https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
• https://www.cms.gov/medicare-coverage-database/indexes/ncd-alphabetical-index.aspx
• Anesthesia in Cardiac Pacemaker Surgery (10.6)
• Use of Visual Tests Prior to and General Anesthesia during Cataract Surgery (10.1)

https://med.noridianmedicare.com/web/jeb/specialties/anesthesia-pain-management#resources

 

[Lori]

Reimbursement:

This modifier is informational only and does not affect reimbursement

Do not report this modifier with procedure codes that include the term “without anesthesia” in the description.

Do not report with procedure codes that are normally performed under general anesthesia.

Definition: Unusual Anesthesia: Occasionally, a procedure, which usually requires either no anesthesia or local anesthesia, because of unusual circumstances must be done under general anesthesia.

Appropriate Usage

• Add modifier 23 to the procedure code of the basic service.
• Report this modifier in the second modifier position. The modifier indicating the service was personally performed, medically directed, or medically supervised should be reported in the first modifier position (please see the anesthesia documentation modifier fact sheet for more information).

Inappropriate Usage

• Do not report this modifier with procedure codes that include the term "without anesthesia" in the description.
• Do not report with procedure codes that are normally performed under general anesthesia.

Additional Information

• This is considered an informational only modifier.

CPT Modifier thread:

Resource - CPT Modifiers

CCO Video Modifiers Made Easy: FREE CCO TOOL: https://www.cco.us/cpt-modifier-decision-grid-tool/ 22- Increased Procedural Services 23- Unusual Anesthesia 24- Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative...

www.cco.community

 

[Lori]

Documentation For Moderate Sedation Tips:​

• The intra-service time is the only time that can be counted to determine the assignment of the CPT code(s);
• CPT has defined the intra-service time as “It begins with the administration of the sedation agent(s), requires continuous face-to-face attendance, and ends when the personal face-to-face time ends with the patient’;
• It is important that you use language that mirrors CPT terminology, other terms used, such as “total time spent was…’ or “encounter time was…’ cannot be counted;
• The pre-sedation and post-sedation work is required, however; none of this time can be calculated to determine code selection;
• Because having a trained independent observer is required to be sure to include this information in your documentation;
• Do not include any of the pre-service and post-service work when calculating the intra-service time

CPT CODE TIPS:

• Whether the same provider is both administering the sedation and performing the procedure for which the sedation is required. Coding changes when a different provider administers the sedation
• Whether the patient is younger than five years of age; or five years old, or older.
• The ‘intra-service time’ of the procedure. Intra-service time begins with the administration of the sedation agent and ends when the procedure is completed, the patient is stable for recovery status, and the provider performing the sedation ends personal continuous face-to-face time with the patient.

Learn what is & is not included in moderate sedation.

Pre & Intra service work defined.

Total Intra-service Time​	Patient age​	CPT Code(s)=Same physician performing procedure​	CPT Code(s)=Different physician who is performing a procedure​
Less than 10 minutes	Any Age	Not reported separately	Not reported separately
10-22 minutes	< 5 years	99151	99155
10-22 minutes	5 years or older	99152	99156
23-37 minutes	< 5 years	99151 + 99153 x1	99155 + 99157 x1
23-37 minutes	5 years or older	99152 + 99153 x1	99156 + 99157 x1
38-52 minutes	< 5 years	99151 + 99153 x2	99155 + 99157 x2
38-52 minutes	5 years or older	99152 + 99153 x2	99156 + 99157 x2
53-67 minutes	< 5 years	99151 + 99153 x3	99155 + 99157 x3
53-67 minutes	5 years or older	99152 + 99153 x3	99156 + 99157 x3
68-82 minutes	< 5 years	99151 + 99153 x4	99155 + 99157 x4
68-82 minutes	5 years or older	99152 + 99153 x4	99156 + 99157 x4

CPT CODE​	DESCRIPTION​
MODERATE SEDATION PERFORMED BY THE SAME PROVIDER​
99151	Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient younger than 5 years of age
99152	Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient age 5 years or older
99153	Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; each additional 15 minutes of intra-service time
MODERATE SEDATION PERFORMED BY ANOTHER PROVIDER​
99155	Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intra-service time, patient younger than 5 years of age
99156	Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intra-service time, patient age 5 years or older
99157	Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intra-service time

Moderate (Conscious) Sedation Coding Guidelines

Moderate sedation are services provided by the physician or other qualified health care professional performing the diagnostic

www.medicalbillersandcoders.com

 

[Lori]

Anesthesia modifiers

 

[Lori]

Medical Coding for Placing of Lines with Anesthesia​

 

[Lori]