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APPLICABLE FOR DATES OF SERVICE PRIOR TO 01/01/2002

POLICY

This policy is applicable to independent practitioners (i.e., anesthesiologists and certified registered nurse anesthetists) as well as hospital-based practitioners who file professional anesthesia services.

Claims Filing Guidelines for State & School Employees’ Health Insurance Plan

Independent and hospital-based anesthesiologists and CRNAs must file both inpatient and outpatient professional anesthesia services on a HCFA-1500 form.

Claims Filing Guidelines for All Other Lines of Business

Independent practitioners (anesthesiologists and CRNAs) must file professional anesthesia services on a HCFA-1500 form.

Hospital-based practitioners (anesthesiologists and CRNAs) must file professional anesthesia services as hospital ancillary services on the UB-92 form. However, if the hospital is participating in Blue Cross & Blue Shield of Mississippi (BCBSMS) APG Reimbursement Program, outpatient professional anesthesia services must be filed on a HCFA-1500 form.

When the professional anesthesia services are filed on a HCFA-1500 form and a CRNA is involved in the administration of the anesthesia, the following rules apply:

• If the CRNA is employed by the supervising anesthesiologist or by the supervising anesthesiologist’s practice/clinic, the CRNA and the supervising anesthesiologist’s services must be filed on the same claim form as single line item. The claim must be filed using the supervising anesthesiologist’s provider identification number. The provider identification number of the CRNA must not be listed on the claim form. Enter the provider identification of the supervising anesthesiologist in Block #33 on the HCFA-1500 form.

• If the CRNA is not employed by the supervising anesthesiologist or by the supervising anesthesiologist’s practice/clinic, the CRNA must file a separate claim using the CRNA’s provider identification number.

• If the CRNA is self-employed and services are not supervised by an anesthesiologist, the CRNA must file a separate claim using the CRNA’s provider identification number.

FILING GUIDELINES FOR GENERAL ANESTHESIA

Generally, when filing general anesthesia services, BCBSMS requires the use of the CPT procedure code and the appropriate HCPCS Level II anesthesia modifier. However, in some instances BCBSMS will accept the American Society of Anesthesiologists (ASA) codes.

ASA codes are accepted on Medicare "crossover" claims. However, if Medicare secondary claims are filed (hardcopy or electronically) directly to BCBSMS, the claim must be filed using the codes and coding guidelines outlined in this bulletin. Other instances when ASA codes are accepted are outlined in this bulletin.

Anesthesia Modifiers

BCBSMS will continue to accept the following modifiers for claims with service dates prior to January 1, 2002 for all lines of business.

Filing General Anesthesia Services When Multiple Surgical Procedures Are Performed

When multiple surgical procedures are performed during an operative setting, only the procedure with the highest anesthesia base units should be reported. It should be noted that the primary surgical procedure is not always the procedure with the highest anesthesia base units. Check the most recent issue of the American Society of Anesthesiologists Relative Value Guide for the procedure with the highest relative value units.

Global Anesthesia Services

The following components are considered an integral part of the global service for general anesthesia and should not be reported separately.

• Pre-anesthesia evaluation (99201-99205, 99221-99223)
• Post-operative visits (99211-99215, 99231-99233)
• Anesthetic or analgesic administration

• Routine, non-invasive monitoring

  • Blood pressure monitoring
  • EKG/ECG monitoring (93000-93015, 93040-93042)
  • Arterial blood gases (82800-82810)
  • Oximetry (94760-94762)
  • Carbon dioxide, expired gas determination/capnography (94770)
  • Pulmonary function tests (94010-94750)
  • Mass spectrometry (83788-83789)

• Intra-operative administration of drugs, IV fluids, blood, etc.
• The set-up, maintenance and supervision of a pain control analgesia (PCA) pump (01997)
• Pharmacological or physical activation requiring physician attendance during EEG recording (95954). This service should be bundled with the global service if the medical necessity is not documented. If the medical necessity is documented, allow a separate allowance for 95954.

Physical Status Modifiers, Qualifying Circumstances, and Specialized Monitoring

The following services are not considered a part of the global service for general anesthesia and can be reported as a separate line item on the claim form. In order to receive the correct reimbursement for these services, they must be submitted on the same form as the global anesthesia services.

Physical Status Modifiers are appended to the global anesthesia service code following the HCPCS Level II modifier (e.g., 25270-AA-P3).

Qualifying Circumstances: Anesthesia time and modifiers are not required with these procedures.

Specialized Monitoring and Other Miscellaneous Procedures: Anesthesia time and modifiers are not required with these procedures.

Guidance Procedures: Anesthesia time and modifiers are not required with these procedures.

When Insertion of an Arterial Line or Catheter Is the Only Service Rendered

When the insertion of an arterial line or catheter is the only service rendered, submit the charge using the appropriate code. Anesthesia modifiers and time are not required.

Anesthesia Time

Anesthesia time should be reported in minutes in Field 24G on the HCFA-1500 form. BCBSMS allows one unit of time for each 15-minute increment of anesthesia time. There is an exception to this policy. See the section entitled "Epidural Anesthesia Administered by an Anesthesiologist and/or CRNA".

Calculating Anesthesia Allowable Charges

Below is the formula used to calculate the allowable charge for general anesthesia.

Anesthesia Allowable Charge = ( Anesthesia Base Units + Anesthesia Time Units + Physical Status Modifier + Qualifying Circumstances + Specializing Monitoring) x Anesthesia Conversion Factor

INSERTION OF AN EPIDURAL CATHETER FOLLOWING GENERAL ANESTHESIA FOR POST-OPERATIVE PAIN MANAGEMENT

Use CPT code 62318 or 62319 to report the insertion of an epidural catheter for post-operative pain management. Anesthesia modifiers and time are not required when reporting the insertion of an epidural catheter.

Use ASA code 01996 to report daily management of an epidural catheter. The anesthesia modifiers and anesthesia time are not required with this code. No benefits are allowed for this service on the day that the catheter is placed. Documentation of medical necessity is required for visits in excess of three (3) days.

PATIENT-CONTROLLED ANALGESIA (PCA) PUMP

The set-up, daily management and supervision of a PCA pump are inclusive in the global anesthesia service when performed by an anesthesiologist or CRNA. This service should not be billed as a separate line item on the claim.

Some out-of-state BCBS Plans allow a separate allowance for services related to PCA pumps management. When billing this service to an out-of-state BCBS Plan that allows a separate allowance, please use code 01997 to report this service, unless advised otherwise by the out-of-state plan. Anesthesia modifiers and time are not required when filing this service.

REGIONAL ANESTHESIA (i.e., BIER or BAER BLOCK)

Regional anesthesia involves the use of a tourniquet to restrict the anesthesia to a region of the body, such as the arm or leg. Use ASA anesthesia code 01995 (Regional IV administration of local anesthetic agent – upper or lower extremity) to report regional anesthesia services. Anesthesia modifiers and time are not required when reporting ASA code 01995.

INTRAVENOUS (IV) SEDATION OR CONSCIOUS SEDATION

Conscious sedation can be administered in a number of ways (i.e., intramuscular, intravenous, inhalation, oral, rectal and/or intranasal). The following CPT codes should be used to report the charge for conscious sedation. Anesthesia modifiers and time are not required when reporting this service.

99141- Sedation with or without analgesia (conscious sedation); intravenous, intramuscular or inhalation

99142 - Sedation with or without analgesia (conscious sedation); oral rectal and/or intranasal

EPIDURAL ANESTHESIA ADMINISTERED BY AN ANESTHESIOLOGIST AND/OR CRNA FOR OBSTETRICAL PROCEDURES

When epidural anesthesia services are performed by an anesthesiologist or CRNA for obstetrical surgical procedures, use ASA codes 00850, 00857, and 00955 to report the service. Anesthesia modifiers and anesthesia time are required with these codes. Anesthesia modifiers and time are not required with code 01996.

The time units for procedure codes 00857 and 00955 are calculated in 30-minute increments rather than 15- minute increments. The maximum time allowed for procedure codes 00857 and 00955 is six (6) hours.

EPIDURAL ANESTHESIA ADMINISTERED BY AN ANESTHESIOLOGIST AND/OR CRNA FOR NON-OBSTETRICAL PROCEDURES

Use the appropriate CPT code (62318 or 62319) and anesthesia modifier to report epidural anesthesia for non-obstetrical procedures. Anesthesia time is required.

PAIN MANAGEMENT (NON-SURGICAL)

Use the appropriate CPT code (e.g., 20550, 20605, 20610, 64400-64530, etc.) to report services for the management of pain not directly related to the performance of a surgical procedure. Anesthesia modifiers and anesthesia time are not required when reporting pain management services.

GENERAL ANESTHESIA FOR RADIOLOGICAL PROCEDURES (MRI & CAT SCAN) OR RADIATION THERAPY

Use the appropriate CPT procedure code for the service performed (i.e., 70551, 70052, 77407, etc.) to report general anesthesia services for non-invasive radiological procedures and radiation therapy.

POLICY EXCEPTIONS

Policy applicable to all lines of business, including the State of MS and the Federal Employee Program (FEP). ASA anesthesia codes are accepted only in the rare instances indicated in the policy, with the exception of Medicare crossover claims. All ASA codes are accepted on Medicare crossover claims.

POLICY GUIDELINES

The coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.

POLICY HISTORY

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