Our anesthesiologist brought it to our attention that if we perform anesthesia on a patient that is younger than a year old and 70 years or older there is a code/modifier to use as we should be reimbursed a higher amount for these situations. Can someone confirm this for me? If we are to be reimbursed at a higher rate for these cases what code/modifier do we bill? Thank you.
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Wiki Anesthesia Coding
- Thread starter alexis.nichole13@hotmail.com
- Start date
dstruve
Networker
Its not really a modifier but a qualifying circumstance code. it is on page 61 of your cpt book. It is another code you add on to your billable anesthesia code.
Thank you!
I have another question: I bill code 00630 for a microdisectomy procedure. The patient is in prone position obviously. Do I bill code 01992 and put the start and stop time like I did on code 00630? Is code 01992 reimbursable?
I have another question: I bill code 00630 for a microdisectomy procedure. The patient is in prone position obviously. Do I bill code 01992 and put the start and stop time like I did on code 00630? Is code 01992 reimbursable?
danachock
Expert
Hi alexis.nichole13@hotmail.com,
I have some advice on this to offer on this please.
First - Yes, dstruve is absolutely correct that under age 1 and over age 70 which is considered a qualifying circumstance is billed with "add on" code 99100; however "for some infant procedures - the base unit value takes patient age into consideration".
You will bill that qualifying circumstance "add on" code on the same claim with your "primary" procedure code. Also be sure to check the insurance. I know that there are insurance carriers out there that expect a modifier on that qualifying circumstance charge just as the primary procedure was billed out (I'm from Central MN and I know of two different carriers).
The second post you made I'm confused on.
I do not have an anesthesia record or the operative report in front of me to provide absolute assistance, only assumptions at this point.
But if you are billing 00630 that has base unit value of 8, whereas if you bill 01992 (for anesthesia for therapeutic nerve blocks in prone position) with 5 base unit value. What was the procedure or procedure(s) really being performed? Are you able to look at the patient's charges to see what CPT codes are being billed for the operative procedure?
Have you also researched field avoidance? This is for any procedure around the head, neck or shoulder girdle, requiring field avoidance, or any procedure requiring a position other than supine or lithotomy, has a minimum base value of 5 regardless of any lesser base value assigned to such procedure in the body of the Relative Value Guide.
Per the Relative Guide Value (provided by the American Society of Anesthesiologists); when multiple surgical procedures during a single anesthetic administration, only the anesthesia code with the highest base unit value is reported." Simply put - you will bill the the procedure that provides the highest level of base unit value with the total time for all the procedures being performed".
Also, what type of anesthesia coding resources do you have access to? Unfortunately some of the healthcare facilities have decided to no longer pay for any resources (especially books). But if you haven't owned a Relative Value Guide or a Crosswalk (A Guide for Surgery/Anesthesia CPT Codes), I would start this year by doing so in my opinion even if you needed to purchase them on your own. The information in those manuals is very helpful when coding anesthesia charges.
I hope you have a wonderful evening & thank you for listening,
Thank you for listening,
Dana
I have some advice on this to offer on this please.
First - Yes, dstruve is absolutely correct that under age 1 and over age 70 which is considered a qualifying circumstance is billed with "add on" code 99100; however "for some infant procedures - the base unit value takes patient age into consideration".
You will bill that qualifying circumstance "add on" code on the same claim with your "primary" procedure code. Also be sure to check the insurance. I know that there are insurance carriers out there that expect a modifier on that qualifying circumstance charge just as the primary procedure was billed out (I'm from Central MN and I know of two different carriers).
The second post you made I'm confused on.
I do not have an anesthesia record or the operative report in front of me to provide absolute assistance, only assumptions at this point.
But if you are billing 00630 that has base unit value of 8, whereas if you bill 01992 (for anesthesia for therapeutic nerve blocks in prone position) with 5 base unit value. What was the procedure or procedure(s) really being performed? Are you able to look at the patient's charges to see what CPT codes are being billed for the operative procedure?
Have you also researched field avoidance? This is for any procedure around the head, neck or shoulder girdle, requiring field avoidance, or any procedure requiring a position other than supine or lithotomy, has a minimum base value of 5 regardless of any lesser base value assigned to such procedure in the body of the Relative Value Guide.
Per the Relative Guide Value (provided by the American Society of Anesthesiologists); when multiple surgical procedures during a single anesthetic administration, only the anesthesia code with the highest base unit value is reported." Simply put - you will bill the the procedure that provides the highest level of base unit value with the total time for all the procedures being performed".
Also, what type of anesthesia coding resources do you have access to? Unfortunately some of the healthcare facilities have decided to no longer pay for any resources (especially books). But if you haven't owned a Relative Value Guide or a Crosswalk (A Guide for Surgery/Anesthesia CPT Codes), I would start this year by doing so in my opinion even if you needed to purchase them on your own. The information in those manuals is very helpful when coding anesthesia charges.
I hope you have a wonderful evening & thank you for listening,
Thank you for listening,
Dana
Last edited:
Thank you so much for this.
As for the first question we are a CRNA that performs our anesthesia so for the anesthesia codes I bill a QZ modifier along with the physical status modifier. So when I bill 99100 as the add on code for those particular patients in that age range are you saying to add on that QZ modifier and physical status modifier?
For the second question that's what I thought (bill the procedure that provides the highest level of base unit value with the total time) My CRNA just wanted me to double check on that. Thank you.
danachock
Expert
Well, first what insurance are you billing? I am unsure what insurance you are billing or what state. Not all insurance carries want/need/require it. Every insurance carrier policy medical rules differ so I simply don't have a cut and dry answer for this. If you are able to review the patient's demographics and identify their primary insurance carrier, then take a moment to google it.
Take that time to find the insurance's medical policy and review their requirements for anesthesia on qualifying circumstances. Yeah - I know that it seems tedious; but once you find it and save that information (you will have it for the next claim).
For the second question - per the Relative Guide Value book - it states that when multiple surgical procedures are performed during the same anesthetic administration that you will bill the procedure that has the highest base unit value with total time for all procedures during that administration. Those folks (insurance carriers) receiving the anesthesia claim will know what the primary procedure being billed is by reviewing the claims for the same DOS (day of service). They have tools to crosswalk and determine that we are billing the correct anesthesia procedure.
Tidbit - I also discovered that if I was super quick about sending an anesthesia claim out the door before the medical procedure was billed by the surgical coder(s) - it was usually flat out denied. They need that the primary procedure claim received before they will process the anesthesia claim. So be sure to keep this in mind when working denials.
I only wish you tons of success with your anesthesia coding!
Have a wonderful evening,
Dana
Take that time to find the insurance's medical policy and review their requirements for anesthesia on qualifying circumstances. Yeah - I know that it seems tedious; but once you find it and save that information (you will have it for the next claim).
For the second question - per the Relative Guide Value book - it states that when multiple surgical procedures are performed during the same anesthetic administration that you will bill the procedure that has the highest base unit value with total time for all procedures during that administration. Those folks (insurance carriers) receiving the anesthesia claim will know what the primary procedure being billed is by reviewing the claims for the same DOS (day of service). They have tools to crosswalk and determine that we are billing the correct anesthesia procedure.
Tidbit - I also discovered that if I was super quick about sending an anesthesia claim out the door before the medical procedure was billed by the surgical coder(s) - it was usually flat out denied. They need that the primary procedure claim received before they will process the anesthesia claim. So be sure to keep this in mind when working denials.
I only wish you tons of success with your anesthesia coding!
Have a wonderful evening,
Dana
Denjen4207
Guest
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Thank everyone for writing about this. I want to make sure I am understanding that when using 99100 we should use AA as well as physical status modier?