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Thread: Can ortho surgeon charge for administering anesthesia?

  1. #1

    Default Can ortho surgeon charge for administering anesthesia?

    AAPC: Back to School
    If the doctor does a case without an anethesiologist, is he able to charge for the administering of a metacarpal block or IV regional block? I have a doctor that wants to start charging for these.

    Thank you!!

  2. #2
    Join Date
    Apr 2007
    Albany, New York


    Yes, according to CPT your physician can code/ charge for this.
    Review the Anesthesia Guidelines in the front of that section in the CPT book.
    Karen Maloney, CPC
    Data Quality Specialist

  3. #3
    Join Date
    Apr 2007

    Default HOWEVER.....CCI Edit state Different.

    CCI Editing states that the provider that performs the service can not bill for anesthesia... Per the CCI Edit by CMS... (Cut and Copied) the anesthesia is included in the medical/surgical package. "Local anesthesia including local infiltration, regional blocks, mild sedation, and all other anesthesia services except moderate conscious sedation reportable as CPT codes 99143-99145 are not separately reportable by a physician performing a medical or surgical procedure". This is ALSO stated in your CPT book in the surgery guidelines section.
    CCI edits also state: Medicare Anesthesia Rules prevent separate payment for
    anesthesia services by the same physician performing a surgical
    or medical procedure. The physician performing a surgical or
    medical procedure should not report CPT codes 90760-90775 for the
    administration of anesthetic agents during the procedure. If it
    is medically reasonable and necessary that a separate provider
    (anesthesia practitioner) perform anesthesia services (e.g.,
    monitored anesthesia care) for a surgical or medical procedure, a
    separate anesthesia service may be reported by the second
    Under the CMS Anesthesia Rules, with limited exceptions, Medicare
    does not allow separate payment for anesthesia services performed
    by the physician who also furnishes the medical or surgical
    service. In this case, payment for the anesthesia service is
    included in the payment for the medical or surgical service. For
    example, separate payment is not allowed for the physician’s
    performance of local, regional, or most other anesthesia
    including nerve blocks if the physician also performs the medical
    or surgical procedure. However, Medicare may allow separate
    payment for moderate conscious sedation services (CPT codes
    99143-99145) when provided by same physician performing the
    medical or surgical procedure except for those procedures listed
    in Appendix G of the CPT Manual.
    I work for an insurance co. and would not pay a physicain for performing his own anesthesia due to the CMS based edit above....

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