Anesthesia and Pain Management

October 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Categories:   Anesthesia|Pain Management   Modifiers   Office of Inspector General (OIG)  

Anesthesia and Pain management is under close watch from the OIG according to a report from Anesthesia Business consultants, they stated, "The Health and Human Services Office of Inspector General (HHS OIG) reports in its most recent Semi-annual Report to Congress that in FY 2017 it brought criminal actions against 881 individuals or organizations engaging in crimes against HHS programs and their beneficiaries, and an additional 826 civil actions, including false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalty settlements and administrative recoveries related to provider self-disclosure matters. OIG excluded 3,244 individuals and entities from participation in federal healthcare programs.”

This is not to mention the public health concern for chronic pain management and the growth of opioids prescribed. The CDC has developed and published guidelines for prescribing opioids for chronic pain to improve the way opioids are prescribed and hopes to reduce the number of patients who misuse or overdose with these drugs.  

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

Anesthesia Billing

Anesthesia is reimbursed for the most part on the amount of time spent providing patient care. Therefore, it is important to correctly record the Start-Stop Time in the medical record. When billing for anesthesia services, there is a formula used to determine the allowed time.  Generally, the Anesthesia formula is as follows (Time Unit + Base Unit) X Conversion Factor = Allowed.

Prior to 2017 moderate sedation was indicated by a red bulls-eye on a CPT code that included moderate sedation. This was removed by the AMA in 2017 that affected over 700 codes. When using these codes moderate sedation needs to be coded separately.

Payment can also be made for anesthesia services with multiple procedures and is based on the procedure with the highest base unit value.

Modifiers for anesthesia billing identify specific situations and are required to report the type of provider that furnished the service.  For example, an anesthesiologist can medically direct several cases at one time done by a qualified Non-physician anesthetist.  If an anesthesiologist is medically supervising more than four concurrent anesthesia procedures the AD modifier is reported. The AA Modifier was the focus of the OIG Anesthesia investigations in 2015.

A few examples of modifiers are:

  • AA- Anesthesia Services performed personally by an anesthesiologist
  • AD – Medical supervision by a physician: more than four concurrent anesthesia procedures
  • QX - CRNA service: with medical direction by a physician

For Medicare, Claims processing see the CMS Manual Pub-100-04

Click Here for a great resource for an anesthesia guide from CMS Palmetto GBA.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?
October 10th, 2023 - Aimee Wilcox
When EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association