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Medical Assistance rules for Anesthesia Billing

  1. Default Medical Assistance rules for Anesthesia Billing
    Medical Coding Books
    Medical Assistance rules for Anesthesia Billing state that "when 2 or more surgical procedures are performed and anesthesia is provided by the same anesthesiologist during the same hospitalization, the anesthesiologist will be paid at 100% for the highest allowable payment for 1 procedure and 25% for the 2nd highest paying procedure and no payment for any additional procedures after that". We would like to know if you are aware of any information out there that would help get Medical Assistance to realize that all surgeries during that one hospitalization were necessary and should be reimbursed to the anesthesiologist. Is anybody else getting paid for multiple surgeries during one hospitalization by using a modifier or appeal process?

  2. #2
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    It seems to me that the rules are pretty fair as they stand. It's not like the patient has to be brought down and then back up again, and then down and back up once more, and so on for each procedure. The work involved with multiple procedures done concurrently is not much different than for a single procedure.

  3. #3
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    scannon,

    What do you mean by "Medical Assistance Rules"? I've been billing anesthesia for 18 years and have not experienced the reimbursement reductions you are detailing.

    Julie, CPC

  4. #4
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    Hi,

    I would not able to understand exactly what you are trying to say. I am working in anesthesia for past five years, as per my knowledge, anethesia service is calculated by timing not by the surgery, for eg.if anesthesiologist done a colectomy, gastrectomy for patient A & done a colonoscopy,EGD for patient B in a different timings on the same day, then we can bill 00790 for patient A and 00740 for patient B. He will get the 100% payment for both procedure. we need to bill only one ASA code which should be the highest ASA units procedure for one patient.

    I think it would be helpful

  5. #5
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    Quote Originally Posted by banumathy View Post
    Hi,

    I would not able to understand exactly what you are trying to say. I am working in anesthesia for past five years, as per my knowledge, anethesia service is calculated by timing not by the surgery, for eg.if anesthesiologist done a colectomy, gastrectomy for patient A & done a colonoscopy,EGD for patient B in a different timings on the same day, then we can bill 00790 for patient A and 00740 for patient B. He will get the 100% payment for both procedure. we need to bill only one ASA code which should be the highest ASA units procedure for one patient.

    I think it would be helpful
    I think the OP meant multiple surgeries on the same patient at the same time, not different patients at the same time. I could be wrong...

  6. Default not clear
    I'm not clear as to what you are asking exactly...are you referring to multiple procedures during one operative session or are you talking about multiple procedures during one hospital stay? If it's multiple procedures during one operative session then you would bill the code with the highest base unit and the time for all the procedures combined (this is per the Anesthesia Answer Book and in the Guidelines in the CPT book), no modifiers are needed even with bilateral. If you are talking about multiple procedures during one hospitalization, I have billed each procedure and not used modifiers and have not had a problem so far.

  7. #7
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    I work for an anes offc and we do not have the problems you are having. If the patient has more than one operation performed during the surgery time bill the highest ASA with all of the time units (I think there was a previous post eluding to this). That's all that should be needed to get your claims paid. If you would like to contact me to discuss further, feel free to do so. I hope I helped!!

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