Anesthesia Coding Billing Guideline that Crosswalks to Pain Management Procedures

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anesthesia codes crosswalk to pain management proceduresHere are the Anesthesia Coding Guidelines that Crosswalks to Pain Management Procedures:

64479 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level
64480 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level (List separately in addition to code for primary procedure)
64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level
64484 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

64490-64492 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic
64493-64495 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral

64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint [when specified as radiofrequency facet neurolysis, cervical]
64634 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint [when specified as radiofrequency facet neurolysis, cervical]
64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint [when specified as radiofrequency facet neurolysis, lumbar or lumbosacral]
64636 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint [when specified as radiofrequency facet neurolysis, lumbar or lumbosacral]

Since all the above codes are image guided and are spinal procedures; the most appropriate Anesthesia codes will be:

01935 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic (Base Unit 5) **** for 64490-64495; 64640
01936 … therapeutic (Base Unit 5)

01992 – Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); prone position – Base Unit 5 (CPT 27096)

Anesthesia Modifiers

AA – Anesthesia services performed personally by an anesthesiologist.
QZ – CRNA service without medical direction by a physician.
Anesthesia Informational Modifiers
QS – Monitored anesthesia care service. (Use with anesthesia procedure codes only, and report the actual anesthesia time on the claim.)

P1 – A normal healthy patient
P2 – A patient with mild systemic disease
P3 – A patient with severe systemic disease

Time Units for Anesthesia Codes that Crosswalk for Pain Management Procedures:
Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is, when the patient may be placed safely under postoperative care.
Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service.

For anesthesia claims, the elapsed time, in minutes, must be reported. You shall convert hours to minutes and enter the total minutes required minutes for the procedure in Item 24G of the CMS-1500 claim form or electronic media claim equivalent.

Enter the time units on 24G (see photo attached). Do not report the the Base Time.

Time spent performing anesthesia services is reported in one minute increments and noted in the unit’s field. To calculate reimbursement for time, the number of minutes reported is divided by 15 (minutes) and rounded up to the next tenth to provide a unit of measure.*

*Example: 96 minutes divided by 15 = 6.4 units.

Reimbursement for time will be rounded to 6.4 units instead of using a whole 6 unit of measure. But you don’t need to report this on the claim form, the payer’s system does the calculation. Just enter the actual minutes.

The allowed amount for reimbursement of anesthesia services rendered is calculated by adding the time units to the base units assigned to the anesthesia code reported and multiplying that sum by the contracted conversion factor.*

*In the example given above the time units would be 3.2 units. The 01936 has a base unit of 5, then 6.4 units added to 5 would give a reimbursement measure of 11.4
If the anesthesia conversion rate for 2018 is at $22:

then 11.4 x $22 would =$250.80

GUIDELINES:
K. Anesthesia for Diagnostic or Therapeutic Nerve Blocks and Services Lower in
“Intensity than Moderate Sedation
If the anesthesiologist or CRNA provides anesthesia for diagnostic or therapeutic nerve blocks or injections and a different provider performs the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using the appropriate CPT code consistent with CPT guidance. The service must meet the criteria for monitored anesthesia care as described in this section. If the anesthesiologist or CRNA provides both the anesthesia service and the block or injection, then the anesthesiologist or CRNA may report the anesthesia service and the injection or block. However, the anesthesia service must meet the requirements for moderate sedation and if a lower level complexity anesthesia service is provided, then the moderate sedation code should not be reported. If the physician performing the medical or surgical procedure also provides a level of
anesthesia lower in intensity than moderate sedation, such as a local or topical anesthesia, then the moderate sedation code should not be reported and no separate payment should be allowed by the A/B MAC.”

Reference: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

G. Anesthesia Time and Calculation of Anesthesia Time Units
“Anesthesia time is defined as the period during which an anesthesia practitioner is present
with the patient. It starts when the anesthesia practitioner begins to prepare the patient for
anesthesia services in the operating room or an equivalent area and ends when the
anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is,
when the patient may be placed safely under postoperative care.

Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time for services furnished, the anesthesia practitioner can add blocks of time around an interruption in anesthesia time as long as the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption.
Actual anesthesia time in minutes is reported on the claim. For anesthesia services furnished, the A/B MAC computes time units by dividing reported anesthesia time by 15 minutes. Round the time unit to one decimal place. The A/B MAC does not recognize time units for CPT code 01996 (daily hospital management of epidural or subarachnoid continuous drug administration)”

Question: We had a physician bill CPT® 27096 and a CRNA bill 01992 with a QZ modifier for work during the same encounter. The documentation supports both billings.

Answer: A CRNA and physician can work together on a case resulting in the CRNA providing the anesthesia and a separate provider performing the procedure. There is no coding edit between the codes. Both providers should be able to file their claims and be reimbursed, provided the documentation is in place.
27096 – Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed
01992 – Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); prone position

QZ – CRNA service: without medical direction by a physician

 

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Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

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