1. 5

    Wiki Anesthesia billing questions on time / units

    Anesthesia Billing question - We have never added the quanity to our claims for time units. From what I see, the claims have processed at the correct rate. Does anyone know how Medicare or other insurance process anesthesia claims? Do they use the time that we have on the claim to calcuate...
  2. K

    Wiki new to Anesthesia Billing for Orthopedic surgery

    Good afternoon, We are going to start using our pain mngt/ anesthesiologist for surgeries performed in a ASC. Typically we used the ASC anesthesiologist for these surgeries in the past. Since we will be now using our own Anesthesiologist we are not sure which code sets we should be utilizing...
  3. S

    Wiki Diagnosis Coding for Anesthesia Claims

    This is a question for those who code anesthesia for hospitals or outpatient surgery centers. How many diagnosis codes do you put on your claims; in other words, do you code them like you would code the surgery or an OP/IP visit with up to 12 diagnosis codes, including HCC codes. I have my CPC...
  4. E

    Wiki Anesthesia for Clinical Trial Procedure

    When reporting anesthesia for a clinical trial procedure (TAVR/TAVI) does the anesthesia claim require modifier Q1, ICD-10 Z00.6, and NCT#?
  5. M

    Wiki Moderate Sedation Time 99152

    Does anyone have any resources on how long intraservice time needs to be to bill 99152. The code says initial 15 minutes. Is that any number of minutes up to 15 min. or is there a certain number that has to be reached.
  6. jkyles

    Wiki Medicare releases anesthesia CFs & BUVs for 2022

    Good morning, Medicare's locality adjusted conversion factors and base unit values for 2022 are now available in this Zip file: That includes the BUVs for the new anesthesia with imaging procedures on the spine. So far as I'm...
  7. T

    Wiki Anesthesia for Colonoscopies - MAC or General

    Our group just recently started providing anesthesia services for colonoscopies (previously sedation was done by the RNs.) We are debating whether colonoscopies should be considered MAC or general anesthesia. Would love to hear how other groups are weighing in on this! Thank you!
  8. 5

    Wiki Anesthesia with pain procedures

    Hello, How do you handle the medical necessity for anesthesia on a procedure that per the LCD, anesthesia is not routinely necessary for the procedures? I think our office needs to have a form or something that documents the reason anesthesia is required for the procedure. Does any one have...
  9. E

    Wiki Office Anesthesia

    When diagnostic aortagram, angiogram, pacemaker changes, and similar procedures are performed in an Office suite (POS 11) do you have any issues with reimbursement to the CRNA's who provide anesthesia and bill separately from the facility for their services ? (State of Missouri)
  10. O

    Wiki Billing for medications when we hire out for Anesthesia services

    Hello and thank you for reading the question! We are in an OBL setting and hire out anesthesia services for one day a week. My question is who bills for the medications that the anesthesia people use? We buy the medication and the service administers to our patients and monitors them. Please...
  11. B

    Wiki Office based anesthesia services

    Hello Our office just started doing a bit of MAC in the office for HDR services, I am running into a bit of problems with insurance companies. We bill anesthesia codes with corresponding modifiers (AA,QS, and status modifiers, POS is 11, diagnosis used is the same as the one in the Op Note...
  12. B

    Wiki Billing software for Anesthesia

    What software is everyone using for anesthesia-specific billing? I'm looking to upgrade from our current platform and I'm currently considering Kareo, MedSuite, and PhyGeneSys. Can anyone share their experiences?
  13. 5

    Wiki two speicalty providers same tax ID number

    Hello Can someone get back to me on how to bill two different specialty under same Tax ID number. I have incidents at the surgery center with when a CRNA and Pain specialty physician both provided services on the same patient on same day and one is getting denied. One is a anesthesia code and...
  14. B

    Wiki Office-Based Anesthesia Billing

    Hello! I have a few anesthesiologists who provide services in an office environment (no facility claim being submitted). Our understanding is that we may submit additional CPTs (aside from the base + time) codes for consideration. Who is billing the following and what are you including /...
  15. L

    Wiki CRNA Questions

    We are adding another maxillofacial surgeon to our Arkansas practice and, though he is certified to administer anesthesia, he has requested us to hire a CRNA to administer anesthesia for all his cases. If moderate (conscious) sedation is administered, can we use CPT codes 99143, 99144, 99145...
  16. J

    Wiki Anesthesia during Kyphoplasty

    I have a doctor questioning whether 01936 accurately reflects the work of the anesthesiologist during a Kyphoplasty. So, what code does everyone use for anesthesia during a Kypho? Thanks in advance for your input. Jennifer
  17. K

    Wiki Anesthesia coding/billing for POS 11

    How/can I bill for anesthesia services done at POS 11 in office? For example, CRNA administered anesthesia for a kyphoplasty case that was in office. Is there a modifier that should be billed besides the QZ?
  18. B

    Wiki General Anesthesia during Excision

    We have a provider who excised a malignant lesion on the forearm under general anesthesia. The problem is that we cannot find a code to bill the MAC anesthesia under. Does anyone have any advice on this?
  19. N

    Wiki CRNA and E&M

    We are getting denials from PA's Medicare for CRNAs when billing 99201 for cancelled procedures. Denial when performed/billed by this type of provider. One claim rep said the service is covered under a CRNA but another rep said this was an error. Is anyone getting payment from MC for these? I...
  20. B

    Wiki anesthesia time calculation for facility on a UB- IP

    Hello I am looking for resources to support what the facility may bill for anesthesia on a UB. I work with auditors who have the belief that the facility may only bill for the technical component therefore this means the OR time and anesthesia time should match most times as the professional...
  21. I

    Wiki anesthesia coding: spinal cord stim/intrathecal pain pumps performed by different DR

    I'm looking for a resource that lists the anesthesia CPT codes I need if an anesthesiologist provided the anesthesia and a separate physician performed things like: implantation of spinal cord stimulator, intrathecal pain pump, radiofrequency thermocoagulation of peripheral nerves - just to name...
  22. B

    Wiki Using E/M codes or CC cpt with 36556 and 31500 for Medicare PROBLEM!

    Good evening! I am hoping for some help on this. I am billing for a pain management doctor/anesthesiologist that goes to the hospital and will see a patient earlier in the day (E/M Codes- 99233/99232/99223) and then insert a catheter (36556) later on in the day (or vice versa) OR he will do an...
  23. E

    Wiki Billing for CRNA performing Aline or CVP

    Our CRNA's are employed the hospital and while working under Medical Direction of our attending Anesthesiologist, they may need to perform supplemental procedures such as Aline insertion or CVP's, which I understand fall under the medical direction guidelines as part of the entire anesthesia...
  24. 5

    Wiki 61070 75809 - what anesthesia code to use?

    Hello, Our provider provided services on a patient using codes 61070 and 75809. This patient needed anesthesia for the service. What would the correct anesthesia cpt code be? Thank you
  25. B

    Wiki New York Workers Comp Billing for Anesthesia

    Hi, Our office typically bills anesthesia (provided in ASCs) in the State of NJ. We're now providing services in NY state, and I understand that are some caveats to billing workers comp carriers. I've been told that we cannot bill U&C, but instead we must bill based on the fee schedule...
  26. C

    Wiki 99152 Moderate Sedation Guidelines?

    Can someone PLEASE provide the proper guidelines in billing moderate sedation code 99152? Our Dr performs a heart cath. He does NOT push the sedation meds himself. The person who actually does push the meds, is NOT an employee within the same practice. He/She is an employee of the hospital. My...
  27. C

    Wiki 99152 Proper Billing Guidelines PLEASE!

    Can someone PLEASE provide the proper guidelines in billing moderate sedation code 99152? Our Dr performs a heart cath. He does NOT push the sedation meds himself. The person who actually does push the meds, is NOT an employee within the same practice. He/She is an employee of the hospital. My...
  28. 5

    Wiki Anesthesia by CRNA

    Hello, We have CRNAs that provide the anesthesia for our pain Doctors at the surgery center. They all work under the same TIN - same medical company, but different NPI numbers. We do have all the correct numbers in the correct box on the claim. We are having issues with insurance companies...
  29. L

    Wiki Aborted Procedure Anesthesia Coding

    I am hoping for some feedback on this one. I have an anesthesiologist who did the anesthesia for a hardware placement and spinal fusion. The anesthesia was initiated and the IONM was started. As a result of the findings on the IONM the ortho decided to abort the procedure. My question is do...
  30. J

    Wiki HELP! Anesthesia - 7 Minute PACU Rule

    Hello, I was wondering if anyone knew the exact publication or compliance guideline set forth by CMS that talks of the general assumption that the anesthesia care team should only need 7 minutes for PACU turnover after a procedure. I already put in a request with CMS but then received the...
  31. E

    Wiki NC Medicare

    We have a CRNA group who performs anesthesia services (non medically directed) for Vascular and Renal patients in a North Carolina facility. The facility is a "Physician Office". (POS 11). Medicare (Palmetta GBA) is denying claims based on "procedure code / bill type inconsistent with POS"...
  32. Y

    Wiki Medi-Cal

    I'm a bit stuck. I've starting working in billing with anesthesia. I recently got 3 Medi-cal denials for Family Pact, Z30.2 with 00851 or 00840, stating services cannot be paid with dx. Can anyone share on this please.
  33. M

    Wiki Labor Epidural started by Anesthesia Dr, another practice CRNA did return bolus

    We bill for a CRNA practice that does the dosing ( bolus) for the patient after the patient already has the Labor Epidural completed by an Anesthesiologist from another billing practice. We don't currently bill for this service however we are currently wonder if we should be billing these...
  34. S

    Wiki PQRS regarding type of anesthesia

    Coding the PQRS #13 requirement, "PACU Reintubation Rate", has a requirement of "Patient underwent general anesthesia facilitated by SGA or ETT". My question is whether Medicare considers LMA to be the same, included, with SGA? (SGA: supraglottic anesthesia. ETT: endotracheal tube. LMA...
  35. B

    Wiki Medicare denying Ultrasound Guidance used with Regional Block Placement

    Since January, CMS has been denying about 85% of our claims for ultrasound guidance 76942-26. Our anesthesiologists use ultrasound guidance when placing nerve blocks for post-operative pain control (sciatic/femoral/etc). Some of our appeals have resulted in the claim being reprocessed, but...
  36. K

    Wiki Concurrency & Medical Direction

    We are getting ready to start medical direction here and I have been asked to find out if there are any codes that are excluded from this? Has anyone had any issues with billing any of the codes with medical direction like open heart, brain, vascular? I was just trying to think of high risk. I...
  37. bekka

    Exam under anesthesia

    Hello, We treat a lot of MR, and autistic patients as an oral surgeon. I though there used to be a CPT code for exam under anesthesia? What do you suggest using now?
  38. A

    Wiki 2016 Anesthesia PQRS Measures.

    Hi, Can any one detailed information about newly added and deleted Pqrs measures in Anesthesia and cross cutting measures for anesthesia.
  39. T

    Wiki Anesthesia billing

    already received anwer
  40. C

    Wiki Screening Colonoscopy and Anestheisia

    Screening Colonoscopy and Anesthesia If a patient is having a screening colonoscopy G0121, G0105, or 45378-33. Lets say a non-medicare patient was coded with a G0121 and DX Z12.11. G0121 is accepted by most commercial insurance companies so this should be fine. When its time to bill...
  41. J

    Wiki Help! New to Ortho Coding!

    OK... So I have determined to use 25320 for the Left scapholunate interossous ligament repair. What about the other code? TIA!! PREOPERATIVE DIAGNOSES: 1. Left radial styloid fracture. 2. Left scapholunate interosseous ligament tear with DISI deformity. POSTOPERATIVE DIAGNOSES: 1. Left...
  42. A

    Wiki Medical Mastermind classic billing software and anesthesia billing

    At the Ambulatory surgical facility where I work, we are experiencing problems when billing for anethesia services to Medical Assistance and Other Medicaid MCOs. Our anesthesia time minutes are being overwritten to be one minute regardless of the anesthesia time we input in our billing software...
  43. C

    Wiki OB Anesthesia Coding for Epidural with No Delivery

    Our anesthesiologist notes the following scenario: "How should we submit the bill for a patient in labor who had an epidural placed for 20 hours after which they decide to stop her induction of labor for a later time. So she had 20 hours of anesthesia for labor but no delivery." I am inclined...
  44. K

    Wiki C/S with urgent hysterectomy

    My anesthesia doctor did the following: Labor epidural placed for VBAC attempt. Went into a C/S. Then patient started hemorrhaging which required an urgent hysterectomy. CPT 59409/01967 for the labor because the VBAC failed, and 59525/01969, anesthesia for cesarean hysterectomy following...
  45. 5

    Wiki anesthesia during 64490 or 64493 procedure

    Hello, I know that anesthesia is "typically not required" with 64490 or 64493 but what if you do need anesthesia with this procedure? What code would you use? We have different opinions here in the office. Some think 01992, 01935, 01936 or 00600 or 00630. Does anyone have any information about...
  46. P

    Wiki Helpful Anesthesia Billing Guidelines Resources

    Hello, Does anyone have any reputable [online] anesthesia coding resources with clear instructions on calculating time units? I've been directed to the 'Anesthesia' website, but did not locate information there. I understand there are many variables to reaching units (i.e. payer specific...
  47. R

    Wiki Cataract surgery and anesthesia

    Can the same physician charge for 66983 (cataract extraction) and also 00142 (anesthesia)?
  48. A

    Wiki Anesthesia Crosswalk for CPT 58970

    Our office provides anesthesia for fertility patients and provides anesthesia for patients undergoing egg retrievals. For many years we have used CPT 58970 which crosswalked only to ASA 00840 for 6 base units. This year, there are now 2 crosswalks, 00940 for 3 base units and 00840 as an...
  49. L

    Wiki Documentation

    Fellow Anesthesia Coders, do you get all you need in your documentation to accurately code for ICD-10? There's been a suggestion in my office to code from the facilities' face sheets. It's been my understanding that we are to only code from our providers' documentation. What do you do when...
  50. R

    Wiki Lung Transplants (32851-54) and ASA 00580

    Any one else seeing denials from CMS for Anesthesia done for Lung Transplants starting about 10/1/15? Initally was told by Medicare contractor that ASA does not match, as service is Lung Transplant-- but this is the only ASA that the CPTs cross to. The NCD 260.9 does not give a list of...