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APPLICABLE FOR DATES OF SERVICE PRIOR TO 01/01/2002Use the following guidelines to file claims with service dates prior to January 1, 2002.
POLICYAPPLICATION OF POLICY AND CLAIMS FILING GUIDELINES
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:
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.
BCBSMS will continue to accept the following modifiers for claims with service dates prior to January 1, 2002 for all lines of business.
Modifier –AA Use modifier -AA to report the administration of anesthesia by an anesthesiologist without the involvement of a CRNA.
Modifier –AB Use modifier -AB to report the administration of anesthesia by a CRNA who is employed by the anesthesiologist (or by his/her practice), who is supervising the services. The CRNA and the supervising anesthesiologist’s charges should be combined and billed as a single line item on the claim form. The supervising anesthesiologist’s provider ID number should be used when filing the claim.
Modifier –AC Use modifier AC to report an anesthesiologist’s services for supervising one or more CRNAs not employed by the anesthesiologist (or by his/her practice).
Modifier –QX Use modifier QX to report the services of a self-employed CRNA or the services of a CRNA that is not employed by the supervising anesthesiologists or his/her practice. This modifier should be used for both medically and not medically directed services.
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.
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.
76986 Ultrasonic guidance, intraoperative
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 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 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.
The coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.