Wiki New Anesthesia Coder...needs Help..

[mad_one80]

Hi all!
I'm new to anesthesia coding and was wondering what the "guidelines" are...for example, if i had codes: 00103, 00300 and 00402 all performed from 1:45pm until 9:45 pm...do i bill all those 3 codes or do i only post bill for the highest paying level of code(00103)?
it's one anesthesiologist, injecting for different procedures performed at the same time/session on the same patient/visit/encounter. the procedures were: 19371-50, 15820-59, 15822-59, 15828-59, 15877-59.

thanks in advance!!!

 

[jdrueppel]

When billing for anesthesia, you bill all time under the code with the highest base unit value.

I see by the CPT codes that some of these procedures may be considered cosmetic. Are you filing all services with health insurance? If a non-covered service (i.e. cosmetic add on procedure) is performed during an insurance covered procedure you may need to "split bill". It is not appropriate to bill anesthesia time for a non-covered service under a covered service code.

Julie, CPC

 

[mad_one80]

thanks julie! really helps....and for this particular procedure...it WAS cosmetic. also, can you please clarify/explain to me what this means: "not appropriate to bill anesthesia time for a non-covered service under a covered service code"?

did you mean that for a cosmetic/non-covered procedure, i wouldn't be allowed to bill anesthesia codes for them(since anesthesia is a covered service code?)

 

[mad_one80]

Also which codes would i use if they both have the same base value unit?

ex: 00160 and 00170 both have 5 base unit values....

thx again!

 

[jdrueppel]

1)For add on cosmetic procedures -
If you are filing a claim to insurance and during this covered procedure event a non-covered service was performed (for example a C-Section with an elective cosmetic abdominoplasty done during the same operative session) you should separate the anesthesia time and split bill the case. The insurance covered procedure is billed to insurance and cosmetic gets billed to patient or facility (if you have a cosmetic agreement with the facility). The most accurate way to separate times is to have the anesthesia provider indicate surgical times for each procedure and separate accordingly. Insurance does not intend to pay any monies for a non-covered/cosmetic procedure, including anesthesia minutes and if you don't split bill then insurance is paying unknowingly.

In the event that all services are cosmetic (like your example) and you are billing the patient or facility then you bill as you normally bill anesthesia. No reason to split bill as no charges are being submitted to insurance.

2) ASA 00160 vs 00170 - I would base which code I selected based on the primary diagnosis for the surgery.

Julie, CPC