UnitedHealthcare's reimbursement policy for anesthesia services is developed in part using the American Society of Anesthesiologists (ASA) Relative Value Guide (RVG®), the ASA CROSSWALK®, and Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Policy Manual, CMS NCCI edits and the CMS National Physician Fee Schedule.
Current Procedural Terminology (CPT®) codes and modifiers and Healthcare Common Procedure Coding System (HCPCS) modifiers identify services rendered. These services may include, but are not limited to, general or regional anesthesia, Monitored Anesthesia Care, or other services to provide the patient the medical care deemed optimal.
The Anesthesia Policy addresses reimbursement of procedural or pain management services that are an integral part of anesthesia services as well as anesthesia services that are an integral part of procedural services.
Find your specific codes below.
This policy contains more codes than can be displayed on one screen. Find your specific code below.
Q: How should anesthesia services performed by the Anesthesia Professional be reported when the medical or surgical procedure is performed by a different physician or other qualified health care professional?
A: For general or monitored anesthesia services, in support of a non-anesthesia service, please refer to the ASA CROSSWALK® and report the appropriate CPT anesthesia code (00100 - 01999).
Q: How should anesthesia services performed by the same physician who also furnishes the medical or surgical procedure be reported?
A: If a physician personally performs the anesthesia for a medical or surgical procedure that he or she also performs, modifier 47 would be appended to the medical or surgical code, and no codes from the anesthesia section of the CPT codebook would be used.
Q: How should anesthesia services be reported when surgery has been cancelled?
A: If surgery is cancelled after the Anesthesia Professional has performed the preoperative examination but before the patient has been prepared for the induction of anesthesia, report the appropriate Evaluation & Management code for the examination only. If surgery is cancelled after the Anesthesia Professional has prepared the patient for induction, report the most applicable anesthesia code with full base and time. The Anesthesia Professional is not required to report the procedure as a discontinued service using modifier 53.
Q: How should a CRNA report anesthesia services?
A: CRNA services should be reported with the appropriate anesthesia modifier QX or QZ. CRNA services must be reported under the supervising physician's name or the employer or entity name under which the CRNA is contracted. In limited circumstances, when the CRNA is credentialed and/or individually contracted by UnitedHealthcare, CRNA services must be reported under the CRNA's name.
Q: How should a teaching anesthesiologist report anesthesia services for two resident cases?
A: Consistent with CMS policy, the teaching anesthesiologist may report the actual Anesthesia Time (see definitions) for each case with modifiers AA and GC.
Q: CPT code 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery) is performed by an Anesthesia Professional for a single anesthetic administration. CPT code 00851 (Anesthesia for intraperitoneal procedures in the lower abdomen including laparoscopy; tubal ligation/transection) is subsequently performed by the same Anesthesia Professional during a separate operative session with a single anesthetic administration on the same date of service for the same patient. How should the anesthesia services be reported?
A: Report CPT code 01967 with the appropriate anesthesia modifier and time. Report CPT code 00851 with the appropriate anesthesia modifier and time and in addition, modifier 59, 76, 77, 78, 79 or XE to indicate the anesthesia service was separate and subsequent to the original anesthesia service reported with CPT code 01967.
Q: When physician medical direction is provided to a Certified Registered Nurse Anesthetist (CRNA) for an anesthesia service and a qualifying circumstance exists, who should report the qualifying circumstance code(s) when the services are reported on separate claims?
A: Both the supervising physician and the CRNA should report the qualifying circumstance code(s), so that the additional unit(s) for the qualifying circumstance code(s) will be added to the Base Unit Value according to the Standard Anesthesia Formula and adjusted by the appropriate anesthesia Modifier Percentage (CRNA reported with modifier QX and physician reported with modifier QK or QY).
Q: When physician medical direction is provided to an Anesthesia Assistant (AA) for an anesthesia service, how should the service for the AA and the supervising physician be reported?
A: UnitedHealthcare aligns with CMS and considers anesthesia assistants eligible for the same level of reimbursement as a CRNA; however, while CRNAs can be either medically directed or work on their own, AAs must work under the medical direction of an anesthesiologist. Therefore, in the instance a physician has medically directed an AA, the AA should report the anesthesia service with modifier QX and the supervising physician should report the same anesthesia service with modifier QK, QY or AD.
Q: Will anesthesia services submitted with modifier 22 qualify for additional reimbursement?
A: Only anesthesia services with a Base Unit Value less than 5 units, appended with modifier 22 for unusual positioning and field avoidance, would be considered for additional reimbursement when submitted with supporting documentation. Modifier 22 reimbursement for anesthesia services with a Base Unit Value less than 5 occurs within the Standard Anesthesia Formula by adding additional base units so that the total base units = 5.
Services with a Base Unit Value of 5 or greater already take positioning and field avoidance (if any) into account. Additionally, physical status modifiers and qualifying circumstance codes may be reported to distinguish various levels of complexity or to identify conditions that significantly affect the character of anesthesia services.
Q: What is the best approach to take to submit supporting documentation for modifier 22?
A: Submit a paper claim using the CMS form accompanied by the requested documentation.
Q: The policy states time-based anesthesia services should be submitted using actual time in one-minute increments. How would minutes be reported for paper and electronic claim submissions?
A: The 1500 Health Insurance Claim Form Reference Instruction Manual located at www.nucc.org provides the following instructions:
Paper Claims with CMS Paper Format 02-12: item number 24G titled Days or Units [lines 1–6] should be completed as follows: