Wiki Spinal anesthesia

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I am new to anesthesia coding and want to get clarification on anesthesia administered in the spine as the main anesthesia. I have been told 2 different things, one person said that you use the nerve block code only and then I was told that you use the crosswalk codes. Could someone please tell me the correct method.
 
Epidural analgesia (pain relief) is commonly used to ease the pain of labor and childbirth but can also be used to provide anesthesia for other types of surgeries
Source: https://jamanetwork.com/journals/jama/fullarticle/1104234

A patient has an epidural block with sedation and monitoring for arthroscopic knee surgery. The anesthesia practitioner reports CPT code 01382 (Anesthesia for diagnostic arthroscopic procedures of knee joint)
Source: https://www.cms.gov/files/document/chapter2cptcodes00000-01999final11.pdf

If it the source of the anesthesia for the surgery, use the CPTs from anesthesia (00XXX) with time.
 
When MAC is used with an epidural or spinal, MAC not considered the primary anesthetic. Therefore, the QS modifier would not be appended. QS is only appended when MAC is the primary method of anesthesia.
I am fairly new to coding surgeries and the first thing I asked is why we do not use the QS modifier here at our facility. The answer I received was that the "new person" in billing said that we don't really need to use it. With that being said, they have not been using it at all and we are not getting denials unless someone in billing is adding it later in the process and I do not know about it. We are using it as a primary method on most of our surgeries. We are a critical access hospital with specialty clinic and rural health clinic attached. Very small rural hospital. What would be the reason that we are not required to use this modifier, when by all rights, I was trained to use it at my previous place of employment. If anyone has a great article/info about aneasthesia coding let me know as I am always looking to be educated. Thank you.
 
I am fairly new to coding surgeries and the first thing I asked is why we do not use the QS modifier here at our facility. The answer I received was that the "new person" in billing said that we don't really need to use it. With that being said, they have not been using it at all and we are not getting denials unless someone in billing is adding it later in the process and I do not know about it. We are using it as a primary method on most of our surgeries. We are a critical access hospital with specialty clinic and rural health clinic attached. Very small rural hospital. What would be the reason that we are not required to use this modifier, when by all rights, I was trained to use it at my previous place of employment. If anyone has a great article/info about aneasthesia coding let me know as I am always looking to be educated. Thank you.
If you have specific questions, feel free to ask me. The QS modifier is only used when MAC is the primary method of anesthesia. If the patient received MAC with an nerve block or epidural, MAC would not be considered the primary anesthesia method making the use of QS inappropriate.
 
Thank you for your reply!! So I should be using the QS modifier. I am going to start adding it going forward when needed. They were told also not to use the physical status modifiers, but I disagree with that also. In fact, billing told them that they should only use P2 or P3. Do most people not use the P1? Also, I know we would never use the P4-P6 because we would transfer the patient before procedures would be needed for those types of patients. I am singing up for an aneasthesia webinar provided by the AAPC hoping that it will help me out with any other questions I have. Looking forward to it.
 
Thank you for your reply!! So I should be using the QS modifier. I am going to start adding it going forward when needed. They were told also not to use the physical status modifiers, but I disagree with that also. In fact, billing told them that they should only use P2 or P3. Do most people not use the P1? Also, I know we would never use the P4-P6 because we would transfer the patient before procedures would be needed for those types of patients. I am singing up for an aneasthesia webinar provided by the AAPC hoping that it will help me out with any other questions I have. Looking forward to it.

Medicare does not pay for P3 or higher, but the physical status modifiers on the anesthesia record should be supported by the documentation on the anesthesia record and should be reported on claims. It’s important to submit a diagnosis that’s on the record to support P3 and higher.
 
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