Services involving administration of anesthesia should be reported by the use of the Current Procedural Terminology (CPT) anesthesia five-digit procedure codes, American Society of Anesthesiologists (ASA) or CPT surgical codes plus a modifier. HMO Blue Texas and Blue Cross and Blue Shield of Texas will require that the appropriate anesthesia modifier be filed on anesthesia services.
An anesthesiologist or a CRNA can provide anesthesia services. The anesthesiologist and the CRNA can bill separately for anesthesia services personally performed. When an anesthesiologist provides medical direction to a CRNA, both the anesthesiologist and the CRNA should bill for the appropriate component of the procedure performed. Each provider should use the appropriate anesthesia modifier.
In keeping with the American Medical Association Current Procedural Terminology (CPT) Book, services involving administration of anesthesia include the usual pre-operative and post-operative visits, the anesthesia care during the procedure, the administration of fluids and/or blood and the usual monitoring services (e.g., ECG, temperature, blood pressure, oximetry, capnography and mass spectrometry). Intra-arterial, central venous, and Swan-Ganz catheter insertion are allowed separately.
Payment Calculation Information
Time units will be determined by using the total time in minutes actually spent performing the procedure. Fifteen minutes is equivalent to one (1) time unit. Time units will be rounded to the tenth. Therefore, if the procedure lasted 49 minutes, the time units in this example would be 3.26 or 3.3 time units. The units
field 24G of the HCFA form should reflect the number of minutes the provider spent on the procedure, (e.g. one hour-thirty minutes should be reflected as (90) in the units field).
Anesthesia time begins when the provider of services physically starts to prepare the patient for induction of anesthesia in the operating room (or equivalent) and ends when the provider of services is no longer in constant attendance and the patient may safely be placed under postoperative supervision.
The basis for determining the base points is the Relative Value Guide published by the American Society of Anesthesiologists (ASA). HMO Blue Texas and Blue Cross and Blue Shield of Texas shall implement any yearly update of the Relative Value Guide within 60 days of receipt. Base points used to process claims will be the base points in effect on the date(s) Covered Services are rendered. The exception to this will be Covered Services provided on dates between the receipt of the Relative Value Guide published by ASA and implementation of the updated material. Claims incurred during the exception period will be priced based on the Relative Value Guide in effect on December 1st of the prior calendar year. Newly established codes will be paid at HMO Blue Texas and Blue Cross and Blue Shield of Texas determined rates until the annual update is implemented.
Physical Status Modifiers – to be billed by anesthesiologists and/or CRNAs
P1 A normal healthy person 0 unit
P2 A patient with mild systemic disease 0 unit
P3 A patient with severe systemic disease 1 unit
P4 A patient with severe systemic disease that is a constant threat to life 2 unit
P5 A moribund patient who is not expected to survive without the operation 3 unit
P6 A declared brain dead patient whose organs are being removed for donor purposes 0 unit
Time units plus base points plus unit value(s) allocated to physical status modifiers and/or qualifying circumstances listed above (if applicable) equals “Y”. Allowable amount equals the anesthesia conversion factor multiplied by “Y”.
Modifier Information Billed by an Anesthesiologist
AA Anesthesia services personally performed by the anesthesiologist
AD Supervision, more than four procedures
QK Medical Direction of two, three or four concurrent anesthesia procedures
QY Medical Direction of one CRNA by an anesthesiologist
Modifier Information Billed by a CRNA
QX Anesthesia, CRNA medically directed
QZ Anesthesia, CRNA not medically directed
1. Every cpt has base unit but this has not to be billed in the claims.
2. Enter the time interval in claim notes field or box 19. As per the insurance requirement.
Ex - Start time 19:00 End time 19:30
3. Units has to be calculdated based on the time interval which has to multiplication of 15 Min. For example 0-15 min is calculated as 1 unit and 15 - 30 Min is calculated as 2 Units.
4.If additional Modifier is required enter into the Modifier field.
What Modification required for EMC file
1. EMC file has to go with Miniutes instead of units which is we are using on regular billing.
2.we need to mention in 2400 loop segment SV1 03 MJ (Minutes) SV 04 number of minutes.