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Thread: Propofol reimbursement...

  1. #1
    Join Date
    Apr 2007

    Default Propofol reimbursement...

    AAPC: Back to School
    We are having a lot of insurance companies that will not pay for the anesthesia/propofol bill. They are saying that it is part of the global period. Is there a modifier by any chance that the billing dept may use to recover payment for the anesthesia portion of the procedure?

  2. #2
    Join Date
    Apr 2007

    Default Reimbursement

    If you are billing for a physician, then no you cannot get paid. It is considered a supply only reimbursed thru Medicare Part A. However, if you are billing from a facility you should not have any problems with reimbursement. Hope this helps!

  3. #3


    Only the anesthesiologist or CRNA can bill for the anesthesia time for Propofol. You have to use ananesthesia physical status modifier (P1-P5) and also a modifer to indicate who performed the service -AA (anesthesiologist), QZ (CRNA, w/o directions), QX (CRNA w/direction), etc.

    We bill 00810 with modifers P1, AA for example.

    This can only be billed under the anesthesiologist name or CRNA name.

    The drug will need to be billed from the ASC.

    We use this drug daily and our ASC and anesthesia group gets paid.

  4. #4
    Join Date
    Apr 2007


    for a CRNA,... would you bill with V58.83? what is likely your primary DX code? is it the use of the drug or the reason of the encounter/procedure?

  5. #5
    Join Date
    Apr 2007
    Columbia, MO


    It would the reason for the procedure. V58.83 is for an encounter to monitor a drug the patient is already taking, using some diagnostic method such as a blood draw or a bone scan, etc.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6

    Default Propofol

    Our anesthesiologist does scope procedures in office settings, she now wants to bill for the drug propofol which she buys, is code j73490 the correct code and will she get paid

    carol f, cpc

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