CPT code 49082, 49083, 49084 - abdominal paracentesis

Procedure Code Changes and Description

• Deleted Codes

* 49080 - Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial

* 49081 - Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); subsequent

• New Codes

* 49082 – Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

* 49083 - with imaging guidance

* 49084 – Peritoneal lavage, including imaging guidance, when performed

• (Do not report 49083 or 49084 in conjunction with 76942, 77002, 77012, 77021)

Example

Diagnosis: Malignant ascites

Procedure: Therapeutic paracentesis

The patient is explained the risks, benefits, and alternatives of the procedure abdominal paracentesis for treatment of her malignant ascites. She fully understood and wished to proceed. Pre-operative sonographic images of the abdomen show a large volume of ascites with a pocket free of bowel loops with the left lower quadrant, this will be our entry point. The overlying skin was prepped and draped 2% lidocaine was utilized for local anesthetic. A 7- french sheath needle was passed via a left lower quadrant approach into the ascitic fluid. Clear, straw-colored ascitic fluid was noted. A total of 7 liters was removed. The sheath was removed; sampling was not taken to pathology. The patient tolerated the procedure well with no apparent complications.

• Correct CPT code: 49082

CPT® Procedure Code Changes

• Revised Parenthetical notes

* 49418 - Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous

* 49419 - Insertion of tunneled intraperitoneal catheter, with subcutaneous port (i.e., totally implantable)

 (49420 has been deleted. To report open placement of a tunneled intraperitoneal catheter for dialysis, use 49421. To report open or percutaneous peritoneal drainage or lavage, see 49020, 49021, 49040, 49041, 49082-49084, as appropriate. To report percutaneous insertion of a tunneled intraperitoneal catheter without subcutaneous port, use 49418)

Paracentesis

*As stated in the ACR--SIR-SPR Practice Parameter for Specifications and Performance of Image-Guided Percutaneous Drainage/Aspiration of Abscesses and Fluid 

Collections:

Image-guided percutaneous aspiration is defined as evacuation or diagnostic sampling of a fluid collection using either a catheter  or a  needle during a single imaging session, with removal of the catheter or needle immediately after the aspiration.

Image-guided percutaneous drainage is defined as  the placement of a catheter using

image guidance to provide continuous drainage of a fluid collection.

*Codes 49082 and 49083 describe a puncture of the abdominal cavity with insertion of a needle or catheter to remove fluid. The catheter/needle is removed at the end of the procedure.

* Code 49082 describes an  abdominal paracentesis performed without imaging guidance.

* Code 49083 describes an abdominal paracentesis performed with imaging guidance.

* Limited sonography for localization of fluid is bundled. If localization  reveals no fluid,and the paracentesis is not performed assign code 76705.

* For 2018, the NCCI Manual notes the following revised language: “Evaluation of an anatomic region and guidance for a needle placement procedure in that anatomic region by the same radiologic modality on the same date of service may be reported separately if the two procedures are performed in different anatomic regions. For example, a physician may report a diagnostic ultrasound CPT code and CPT code 76942 (ultrasonic guidance for needle placement...) when performed in different anatomic regions on the same date of service. Physicians should not avoid these edits based on this principle by requiring patients to have the procedures performed on different dates of service if historically the evaluation of the anatomic region and guidance for needle biopsy procedures were performed on the same date of service.” -

Peritoneal Catheter Placements

• 49082 Paracentesis; Dx or Tx, w/o imaging guidance

• 49083 Paracentesis; Dx or Tx, with imaging guidance

• If does paracentesis and leaves catheter in place, use 49406 only.Do not code for the paracentesis.

• If places indwelling catheter, sends to floor for drainage, then pulls catheter on same DOS, use 49083

Paracentesis is the aspiration of fluid from the abdominal cavity. It is most often performed for ascites, which is an abnormal accumulation of peritoneal fluid caused by liver disease, cancer or other conditions. Paracentesis may be performed for diagnostic purposes, in which case only a small amount of fluid is removed. Alternatively, large volume paracentesis (removal of up to 6 liters of fluid) may be performed for therapeutic purposes. Following large volume paracentesis the patient may receive an albumin infusion to prevent electrolyte imbalance.

The following codes are used to report paracentesis:

CPT® Code Description

49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

49083 . . . with imaging guidance

Remember that aspiration involves removal of the catheter or needle at the conclusion of the procedure. Do not use codes 49082-49083 for drainage procedures in which a catheter is left indwelling.

Correspondence Language Policy/Example Number 14.40000 - Misuse of column two code with column one code

For example, CPT code 49322 describes a surgical laparoscopy with aspiration of single or multiple cavities or cysts (eg, ovarian cyst). CPT code 49082 describes an abdominal paracentesis (diagnostic or therapeutic) without imaging guidance. It is a misuse of CPT code 49082 to report it in addition to CPT code 49322 at the same

patient encounter since the procedure described by CPT code 49322 includes the procedure described by CPT code 49082

Guidelines from UHC insurance 

The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. The listing of a code does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies and Guidelines may apply

CPT Code Description

49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

CPT 47560, 47561, 47562, 47563, 47564, 47570 and 47579

Procedure code and Description 

47560 Laparoscopy, surgical; with guided transhepatic cholangiography, without biopsy

47561 with guided transhepatic cholangiography with biopsy

47562 cholecystectomy

47563 cholecystectomy with cholangiography

47564 cholecystectomy with exploration of common duct

47570 cholecystoenterostomy

47579 Unlisted laparoscopy procedure, biliary tract

47560, 47561 have been deleted. To report laparoscopically guided transhepatic cholangiograpy with biopsy, use 47579

Select Laparoscopic Cholecystectomy with Common Bile Duct Exploration (CBDE) Procedures

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.

The following codes are thought to be relevant to Laparoscopic Cholecystectomy with Common Bile Duct Exploration (CBDE) procedures and are referenced throughout this guide.

All rates shown are 2020 Medicare national averages; actual rates will vary geographically and/or by individual facility.

Physician Coding and Payment

Code Description Work Total Facility In-Facility

47564 Laparoscopy, surgical; cholecystectomy with exploration of common duct 18.00 32.48 $1,172

Medicare Hospital Inpatient Payment Rates Effective October 1, 2019 - September 30, 2020

Medicare Severity Diagnosis Related Groups (MS-DRGs) assignment is based on a combination of diagnoses and procedure codes reported. While MS-DRGs listed in this guide represent likely assignments, Boston Scientific cannot guarantee assignment to any one specific MS-DRG. MS-DRGs resulting from inpatient laparoscopic cholecystectomy with common bile duct exploration procedures may include (but are not limited to):

A Whipple-type pancreatectomy procedure (CPT codes 48150-48154) includes removal of the gallbladder. A cholecystectomy (e.g., CPT codes 47562-47564, 47600-47620) shall not be reported separately.

Description

This policy addresses coding and coverage when an operative cholangiography is performed to evaluate the biliary tract and help decide whether or not to explore the common bile duct for stones or other abnormalities.

Definitions

Operative cholangiography involves the injection of radiopaque contrast material into the cystic or common bile duct during surgery. This procedure is performed to identify various abnormalities of the biliary ductal system, often secondary to stones (calculi or choledocholithiasis) and occasionally other lesions, such as benign strictures or tumors.

Policy Statement

Frequently during cholecystectomy, an operative cholangiogram is performed to help the surgeon decide whether or not to explore the common bile duct for stones or other pathologic processes.

When one physician reports the cholecystectomy and operative cholangiography with subsequent common bile duct exploration, the services are combined under the procedure codes 47564 (laparoscopic approach) or 47610 (open/excision approach), as appropriate. If additional surgical procedures are performed during the same operative session, then the modifier 59 may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day. When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines.

If, however, a second physician (e.g., a radiologist) provides the formal interpretation of the operative cholangiography, then the service is eligible for coverage under codes 74300-74301 (cholangiography and/or pancreatography).

Documentation Submission

Documentation/operative report must identify and describe the procedures performed. If a denial is appealed, this documentation must be submitted with the appeal.

Coverage

Eligible surgical services will be subject to the Blue Cross fee schedule amount. Denied services will be provider liability.

The following applies to all claim submissions.

All coding and reimbursement is are subject to all terms of the Provider Service Agreement and subject to changes, updates, or other requirements of coding rules and guidelines. All codes are subject to federal HIPAA rules, and in the case of medical code sets (HCPCS, CPT, ICD), only codes valid for the date of service may be submitted or accepted. Reimbursement for all Health Services is subject to current Blue Cross Medical Policy criteria, policies found in Provider Policy and Procedure Manual sections, Reimbursement Policies and all other provisions of the Provider Service Agreement (Agreement).

In the event that any new codes are developed during the course of Provider's Agreement, such new codes will be reimbursed according to the standard or applicable Blue Cross fee schedule until such time as a new agreement is reached and supersedes the Provider's current Agreement.

All payment for codes based on Relative Value Units (RVU) will include a site of service differential and will be calculated, if appropriate, using the appropriate facility or non-facility components, based on the site of service identified, as submitted by Provider.

Coding

The following codes are included below for informational purposes only and are subject to change without notice. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement.

CPT / HCPCS Modifier: 59

ICD Diagnosis: N/A

ICD Procedure: N/A

HCPCS: 47564, 47610, 74300, 74301

Revenue Codes: N/A

Deleted Codes: N/A

LAPAROSCOPY

Surgical laparoscopy always includes diagnostic laparoscopy. To report a diagnostic laparoscopy (peritoneoscopy) (separate procedure), use 49320.

EXCISION

47600 Cholecystectomy;

47605 with cholangiography (For laparoscopic approach, see 47562-47564) 

The five-digit numeric codes and descriptions included in the Medical Reimbursement Schedule are obtained from the Physicians’ Current Procedural Terminology, copyright 1999 by the American Medical Association (CPT). CPT is a listing of descriptive terms and numeric identifying codes and modifiers for reporting medical services and procedures performed by physicians and other health care providers.

This publication includes only CPT numeric identifying codes and modifiers for reporting medical services and procedures that were selected by the Louisiana Department of Labor, Office of Workers’ Compensation. Any use of CPT outside the fee schedule should refer to the Physicians’ Current Procedural Terminology, copyright 1999 American Medical Association and any update thereto. These CPT publications contain the complete and most current listing of CPT descriptive terms and numeric identifying codes and modifiers for reporting medical services and procedures.

No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of the Physicians’ Current Procedural Terminology, copyright 1999, by the American Medical Association. All rights reserved

Maximum Fee Allowance Schedule Office of Workers' Compensation

CPT Global Maximum

Code Mod Description Days Allowance

47564 Laparo cholecystectomy explr. 90 BR

CPT code 87635, 87426, 87428, 87811

Procedure code and Description

 CPT 87635 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

CPT 87426 - Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

CPT 87428 severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B

CPT 87811 - Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

COVID-19 Billing Guides Updated with CPT Codes 87426 and 86413

Nevada Medicaid has updated the COVID-19 General Billing Guide and COVID-19 Community-Based Testing Billing Guide with the following new Current Procedural Terminology (CPT) codes. These codes have also been added to the Medicaid Management Information System (MMIS) and are active for billing. The Centers for Medicare &

Medicaid Services (CMS) has not established reimbursement rates; therefore, claims will suspend for payment with error code 853 (HCPCS Annual Update – suspend claims) and will be automatically reprocessed once rates have been established by CMS.

Claims for codes 87426 and 86413 that denied with error code 4032 (Procedure code not on file) may be resubmitted back to the dates indicated below.

o Note: Code 87426 is an add-on code under 87301. 87426 became effective by the American Medical Association on June 25, 2020. Claims may only be submitted back to this date.

o Note: 86413 became effective by the American Medical Association on September 8, 2020. Claims may only be submitted back to this date.

Background

Currently, there are two existing CPT codes to report antigen testing using immunoassay technique for influenza type A or B (87400) and SARS-CoV-2 (87426). However, there is no code that describes multiplex immunoassay antigen testing for these three viral targets, ie, SARS-CoV, SARS-CoV-2 [COVID-19], and influenza virus types A and B. A code to report a multiplex viral pathogen panel using an antigen immunoassay technique would facilitate reporting SARS-CoV-2 testing, along with influenza types A and B in the differential diagnosis

The following clinical example and procedural description reflect a typical clinical situation for which this new code would be appropriately reported. Because of the early deployment and utilization of these tests, clinical indications are subject to further refinement as knowledge of the novel coronavirus evolves. The Panel will continue to review and may clarify these indications as more information becomes available.

Clinical Example (87428)

A 50-year-old female presents with fever, cough, and shortness of breath. A nasopharyngeal swab is collected for SARS CoV-2, influenza A, and influenza B antigen testing. 

Description of Procedure (87428)

Place the swab and swirl it in a supplied reagent tube to disrupt and release viral nucleoprotein antigens; transfer an aliquot of that sample to the test cassette sample well; and place it in the analyzer. Report the qualitative results to the ordering health care professional.

COVID-19 Diagnostic Testing Reimbursement

The Centers for Medicare & Medicaid Services (CMS) has established two Healthcare Common Procedure Coding System (HCPCS) codes for coronavirus testing. HCPCS code U0001 is for CDC approved labs to use, and HCPCS code U0002 is for CDC non-approved labs to use when reporting SARS-CoV-2 testing. 

COVID-19 Testing

CMS has established two new HCPCS codes for high throughput technology testing. HCPCS code U0003 and U0004 are to be used when making use of high throughput technologies, as described by CMS2020-01-R. These codes are effective on/ or after 4/14/2020. CMS has established new specimen collections codes for Clinical diagnostic laboratories billing for COVID-19 testing:

** HCPCS G2023- for specimen collection for severe acute respiratory syndrome, any specimen source and

** HCPCS G2024- for specimen collection for severe acute respiratory syndrome, from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source.

Clinical diagnostic laboratories should use these codes to identify specimen collection for COVID-19 testing, effective with item date of service on/or after March 1, 2020. 

The AMA published CPT code 87635 in an effort to help report and track testing services related to SARS-CoV-2 in an effort to assist in reporting and reimbursement.

Medica’s reimbursement rates are based upon rates that were recently announced by the Centers for Medicare and Medicaid Services for COVID-19 testing. Medica will reimburse contracted and noncontracted providers for COVID-19 testing, unless otherwise specified by law. It is not considered medically necessary if a COVID-19 antibody test is to be used as part of ‘return-to-work’ programs, public health surveillance testing or any efforts not associated with disease diagnosis or treatment.

Reimbursement Rates for Coronavirus Diagnostic Testing:

** HCPCS U0001: $35.92

** HCPCS U0002: $51.33

** HCPCS U0003: $75.00 (effective date 4/14/2020)

** HCPCS U0004: $75.00 (effective date 4/14/2020)

** HCPCS U0005: $25.00 (Effective 1/1/2021)

** CPT 87635: $51.33

** HCPCS G2023: $23.46

** HCPCS G2024: $25.46

** HCPCS C9803: $24.67

Diagnosis Codes to be used for confirmed Coronavirus:

** B97.29: Other coronavirus

** B34.2: Coronavirus Infection

** U07.1: 2019 COVID acute respiratory disease

Diagnosis Codes recommended by the CDC for suspected Coronavirus exposure:

** Z03.818: Encounter for observation for suspected exposure to other biological agents ruled out

** Z20.828: Contact with and (suspected) exposure to other viral communicable diseases

** Z11.52: Encounter for screening for COVID-19 (Effective 1/1/21)

** Z20.822: Contact with and (suspected) exposure to CIVUD-19 (Effective 1/1/21)

CPT 99401, 99402, g0446, g0447 and G0473

 CPT CODE and Description

• 99401 – preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 15 minutes

• 99402 – preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 30 minutes

HCPCS codes related to obesity screening and counseling are: 

• G0446 – annual, face-to-face intensive behavioral counseling (IBT) for cardio-vascular disease (CVD), individual, 15 minutes

• G0447 – face-to-face behavioral counseling for obesity, 15 minutes

• G0473 – face-to-face behavioral counseling for obesity, group (2–10), 30 minutes. 

Overview

This policy describes Optum’s requirements for the reimbursement and documentation of “Obesity Screening and Counseling” –CPT codes 99401 and 99402, and HCPCS procedural codes G0446, G0447 and G0473.

The purpose of this policy is to ensure that Optum reimburses for services that are billed and documented, without reimbursing for billing submission or data entry errors or for non-documented services.

Reimbursement Guidelines

For eligible adult health plan members with obesity, defined as Body Mass Index (BMI) equal to or greater than 30 kg/m2 , Optum will align reimbursement with Medicare including:

° One face-to-face visit every week for the first month;

° One face-to-face visit every other week for months 2-6; and

° One face-to-face visit every month for months 7-12 [if the member meets the 3kg (6.6 lbs.) weight loss requirement during the first 6 months.

For adult members who do not achieve a weight loss of at least 3 kg (6.6 pounds) during the first 6 months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period. 

These visits must be provided by a qualified health care provider.

For eligible children and adolescent (6-18 years) health plan members with overweight, defined as having an age/gender-specific BMI at or above the 85th percentile, Optum will align reimbursement with the recommendations of the U.S. Preventive Services

COUNSELING, RISK FACTOR REDUCTION, AND BEHAVIOR CHANGE INTERVENTION CODES

▶ Used to report services provided for the purpose of promoting health and preventing illness or injury.

▶ They are distinct from other E/M services that may be reported separately when performed. However, one exception is you cannot report counseling codes (99401–99404) in addition to preventive medicine service codes (99381–99385 and 99391–99395).

▶ Counseling will vary with age and address such issues as family dynamics, diet and exercise, sexual practices, injury prevention, dental health, and diagnostic or laboratory test results available at the time of the encounter.

▶ Codes are time-based, where the appropriate code is selected according to the approximate time spent providing the service.  Codes may be reported when the midpoint for that time has passed. For example, once 8 minutes are documented, one may report 99401.

▶ Extent of counseling or risk factor reduction intervention must be documented in the patient chart to qualify the service based on time.

▶ Counseling or interventions are used for persons without a specific illness for which the counseling might otherwise be used as part of treatment.

▶ Cannot be reported with patients who have symptoms or established illness

Background Information

Obesity screening and counseling is one of a number of distinct preventive services mandated by national and state regulations [US Dept. of Labor]. The USPSTF recommends screening all adults for obesity [Moyer]. The screening of children >6 years old is also recommended in a separate report [USPSTF]. The USPSTF did not find sufficient evidence for screening children younger than age 6 years. Many different types of providers – not limited to but including chiropractors, physical and occupational therapists – can offer screening and counseling for obesity [Frerichs, Ndetan]. Screening for obesity is typically performed by calculating body mass index (BMI). Counseling and behavioral interventions generally consist of problem-solving (assisting by providing specific suggested actions and motivational counseling) and facilitating access to social support services (arranging for services and follow-up) [ChiroCode, MLN].

Medicare covers screening for adult beneficiaries with obesity, defined as Body Mass Index (BMI) equal to or greater than 30 kg/m2

, who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting. Those who meet these criteria are eligible for:

• One face-to-face visit every week for the first month;

• One face-to-face visit every other week for months 2-6; and

• One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg (6.6 lbs.) weight loss requirement during the first 6 months [MLN].

For beneficiaries who do not achieve a weight loss of at least 3 kg (6.6 pounds) during the first 6 months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period. Medicare does not allow the billing of other services provided on the same day as an obesity counseling visit, but private plans have a wide array of policies on such care. They vary with regard to how the visit should be coded, how many visits are allowed in a year, and in reimbursement design [Elliott].

For children and adolescents ages 6-18 years, the USPSTF uses the following terms to define categories of increased BMI:

• Overweight = an age/gender-specific BMI between the 85th and 95th percentiles

• Obesity = an age/gender-specific BMI at or above the 95th percentile.

The USPSTF did not find any evidence describing the appropriate timing of screening intervals. 

Service Procedure Codes Diagnosis Codes

Screening for obesity in adults, children and adolescents Preventive Medicine Individual Counseling:

• 99401 – 99404 (Diagnosis Code Required) Behavioral Counseling or Therapy:

• G0446, G0447, G0473 (Diagnosis Code Not Required) 

• ICD‐10: Z68.41, Z68.42, Z68.43, Z68.44, Z68.45 

Obesity:

• ICD‐10: E66.01, E66.09, E66.1, E66.8, E66.9 

Most used Anesthesia CPT codes and time units

Anesthesia CPT codes and Time units

00100 ANESTHESIA PROC SALIVARY GLANDS INCLUDING BIOPSY 5
00102 ANES-PROC INVOLVING PLASTIC REPAIR CLEFT LIP 6
00103 ANESTHESIA RECONSTRUCTIVE PROCEDURES OF EYELID 5
00104 ANESTHESIA FOR ELECTROCONVULSIVE THERAPY 4
00120 ANES-PROC EXTERNAL MIDDLE&INNER EAR INCL BX; NOS 5
00124 ANES-PROC EXT MID&INNR EAR INCL BX; OTOSCOPY 4
00126 ANES-PROC EXT MID&INNR EAR INCL BX; TYMPANOTOMY 4
00140 ANESTHESIA FOR PROCEDURES ON EYE; NOS 5
00142 ANESTHESIA FOR PROCEDURES ON EYE; LENS SURGERY
00144 ANESTHESIA PROCEDURES ON EYE; CORNEAL TRANSPLANT 6
00145 ANESTHESIA PROCEDURES EYE; VITREORETINAL SURGERY 6
00147 ANESTHESIA FOR PROCEDURES ON EYE; IRIDECTOMY
00148 ANESTHESIA FOR PROCEDURES ON EYE; OPHTHALMOSCOPY 4
00160 ANESTHESIA PROC NOSE&ACCESSORY SINUSES; NOS 5
00162 ANES-PROC NOSE&ACCESS SINUSES; RADICAL SURGERY 7
00164 ANES-PROC NOSE&ACCESS SINUSES; BX SOFT TISSUE 4
00170 ANES-INTRAORAL INCLUDING BIOPSY; NOS 5
00172 ANES-INTRAORAL INCLUDING BX; REPAIR CLEFT PALATE 6
00174 ANES-INTRAORL INCL BX; EXC RETROPHARYNG TUMR 6
00176 ANES-INTRAORAL INCLUDING BIOPSY; RADICAL SURGERY 7
00190 ANESTHESIA PROCEDURES FACIAL BONES OR SKULL; NOS 5
00192 ANES-PROC FACIAL BONES/SKULL; RADICAL SURGERY 7
00210 ANES-INTRACRAN; NOT OTHERWISE SPECIFIED 11
00212 ANES-INTRACRAN; SUBDURAL TAPS 5
00214 ANES-INTRACRAN; BURR HOLES INCL VENTRICULOGRAPHY 9
00215 ANES-INTRACRAN;PLASTY/ELEV SKULL FX-XTRADURL 9
00216 ANES-INTRACRAN; VASCULAR PROCEDURES 15
00218 ANES-INTRACRAN; PROCEDURES IN SITTING POSITION 13
00220 ANES-INTRACRAN; CEREBROSP FL SHUNTING PROCEDURES 10
00222 ANES-INTRACRAN; ELECTROCOAGULAT INTRACRAN NERVE 6
00300 ANES-INTEG SYST MUSC&NERV HEAD NECK TRUNK;NOS 5
00320 ANES-PROC ESOPH THYRD TRACHEA&LYMPH; NOS 1 YR/> 6
00322 ANES-PROC ESOPH THYROID TRACH LYMPH;BX THYROID 3
00326 ANES-ON THE LARYNX&TRACHEA CHILDREN < 1 YEAR AGE
00350 ANESTHESIA PROCEDURES MAJOR VESSELS OF NECK; NOS 10
00352 ANES-PROC MAJOR VESSELS NECK; SIMPLE LIGATION 5
00400 ANES-PROC INTEG SYS EXTREM ANT TRNK&PERIN; NOS 3
00402 ANES-INTEG SYST EXTREM TRUNK PERIN;BREAST RECON 5
00404 ANES-INTEG EXTREM TRUNK;RADL/MOD RAD BREAST PROC 5
00406 ANES-INTEG EXTREM TRUNK;RADL BRST W/NODE DISSECT 13
00410 ANES-INTEG EXTREM TRUNK PERINEM;CONVERT ARRYTH 4
00450 ANESTHESIA PROCEDURES CLAVICLE AND SCAPULA; NOS 5
00452 ANES-PROC CLAVICLE&SCAPULA; RADICAL SURGERY 6
00454 ANES-PROC CLAVICLE&SCAPULA; BIOPSY CLAVICLE 3
00470 ANESTHESIA FOR PARTIAL RIB RESECTION; NOS 6

Time  Units

In calculating units of time, use 10 minutes per unit. If a medical provider bills for a portion of 10 minutes, round the time up to the next 10 minutes and reimburse one unit for the portion of time. (See Subsection A, Payment Ground Rules for Anesthesia Services, for additional information on reporting of time units.)

Multiple Procedures

Anesthesia reimbursement for multiple procedures is based on the procedure with the highest base value, plus modifying units (if appropriate), plus total time units for all combined surgical procedures.

No additional base value shall be reimbursed for anesthesia rendered during additional surgical procedures (other than the primary procedure) performed on the same day during the same operative setting.

Reimbursement Guidelines

Anesthesia services must be submitted with an appropriate anesthesia payment modifier toindicate the number of providers and roles involved in the anesthesia service. Effective for claims processed on or after July 1, 2018, regardless of date of service, claims for anesthesia services submitted without an appropriate payment modifier will be denied as a billing error for lack of a required modifier. A corrected claim will need to be submitted with the appropriate modifier(s) added.

One anesthesia provider at a time shall be reimbursed per patient. The only exception is supervised anesthesia services by a CRNA under the medical direction of a physician.

If two anesthesia services claims are received for the same patient, same date of service, and the payment modifiers do not agree about the medical direction or supervision performed, the first claim processed will be allowed. The second claim processed is subject to denial as a billing error due to lack of consistent information about who performed the service. No adjustment for reimbursement to the second anesthesia provider can be made until a corrected claim is received from the first (allowed) anesthesia provider so that the payment modifiers on both claims agree about who performed which responsibilities in the anesthesia service. The billing office for the denied claim is responsible to contact the billing office for the other anesthesia provider involved (supervised CRNA or physician providing medical direction) and arrange for the submission of the needed corrected claim.