Anesthesia Guidelines

(1) General Information and Instructions MEDICAL FEE SCHEDULE CHAPTER 0800-02-18 (a) When anesthesia is personally administered by an Anesthesiologist or Certified Registered Nurse Anesthetist (“CRNA”) who remains in constant attendance during the procedure, for the sole purpose of rendering such anesthesia service, reimbursement shall be 100% of the maximum allowable fee based on Time Values and the Base Units included in the fee schedule rate tables. (b) When anesthesia is administered by a CRNA not under the medical direction of an anesthesiologist, maximum reimbursement shall be 90% of the maximum allowable fee for anesthesiologists under these Medical Fee Schedule Rules. No additional payment will be made to any physician supervising the CRNA. (c) Whenever anesthesia services are provided by an anesthesiologist or other physician and a CRNA, reimbursement shall never exceed 100% of the maximum amount an anesthesiologist or physician would have been allowed under these Medical Fee Schedule Rules had the anesthesiologist or physician alone performed these services. (2) Anesthesia Values. Each anesthesia service contains two components which make up the charge and determine reimbursement: a Base Unit and a Time Value. Physical status modifiers and qualifying circumstance codes may be appropriately added according to Medicare guidelines in effect for the date of service. (a) Base Unit: This relates to the complexity of the service and includes the value of all usual anesthesia services except the time actually spent in anesthesia care and any modifiers. The Base Unit includes usual preoperative and postoperative visits, the anesthesia care during the procedure, the administration of fluids and/or blood products incidental to the anesthesia or surgery and interpretation of non-invasive monitoring (ECG, temperature, blood pressure, oximetry, capnography, and mass spectrometry). When multiple surgical procedures are performed during an operative session, the Base Unit for anesthesia is the Base Unit for the procedure with the highest unit value. The Base Units for each anesthesia procedure code are listed in the rate tables. (b) Time Value: Anesthesia time starts when the anesthesiologist or CRNA begins to prepare the patient for induction of anesthesia and ends when the personal attendance of the anesthesiologist or CRNA is no longer required and the patient can be safely placed under customary, postoperative supervision. Anesthesia time shall be reported on the claim form as the total number of minutes of anesthesia. For example, one hour and eleven minutes equals 71 minutes of anesthesia. The Time Value is converted into units for reimbursement as follows: 1. Each 15 minutes equals one (1) time unit. 2. An additional time unit shall be billed when an additional 1–15 minutes of anesthesia time has elapsed. 3. No additional time units are allowed for recovery room observation monitoring after the patient can be safely placed under customary post-operative supervision. (3) Total Anesthesia Value (a) The total anesthesia value (“TAV”) for an anesthesia service is the sum of the Base Unit (units) plus the Time Value which has been converted into units, and physical status modifiers and qualifying circumstance codes that may be appropriately added according to Medicare guidelines in effect for the date of service. The TAV is calculated for the purpose of determining reimbursement. MEDICAL FEE SCHEDULE CHAPTER 0800-02-18 (4) Billing (a) Anesthesia services shall be reported by entering the appropriate anesthesia procedure code and descriptor into Element 24 D of the CMS-1500 Form or the electronic equivalent. The provider’s usual total charge for the anesthesia service shall be entered in Element 24 F on the CMS-1500 Form, or its presently accepted equivalent. The total time in minutes shall be entered in Element 24 G of the CMS- 1500 Form. Include the appropriate modifiers. (5) Reimbursement (a) Reimbursement for anesthesia services shall not exceed the maximum allowable Medical Fee Schedule amount of $75 per unit. (6) Medical Direction Provided by Anesthesiologists (a) When an anesthesiologist is not personally administering the anesthesia but is providing medical direction for the services of a nurse anesthetist who is not employed by the anesthesiologist, the anesthesiologist may bill for the medical direction. Medical direction includes the pre- and post-operative evaluation of the patient. The anesthesiologist shall remain within the operating suite, including the pre-anesthesia and post-anesthesia recovery areas, except in an appropriately documented emergency situation. Total reimbursement for the nurse anesthetist and the anesthesiologist shall not exceed the maximum amount allowable under the Medical Fee Schedule Rules had the anesthesiologist alone performed the services. (7) Anesthesia by Surgeon (a) Local Anesthesia: When infiltration, digital block or topical anesthesia is administered by the operating surgeon or surgeon’s assistant, reimbursement for the procedure and anesthesia are included in the global reimbursement for the procedure. (b) Regional or General Anesthesia: When regional or general anesthesia is provided by the operating surgeon or surgeon’s assistant, payment is included in the surgical procedure reimbursement, according to Medicare guidelines. (8) Unlisted Service, Procedure or Base Unit: When an unlisted service or procedure is provided or a Base Unit is not listed in the rate tables, the value per unit used shall be substantiated by report. (9) Actual time of beginning and duration of anesthesia time may require documentation, such as a copy of the anesthesia record in the hospital file. (10) Special Supplies: Supplies and materials provided by the physician over and above those usually included with the office visit or other services rendered may be listed separately. Drugs, materials provided, and tray supplies shall be listed separately. Supplies and materials provided in a hospital or other facility shall not be billed separately by the physician or CRNA. (11) Separate or Multiple Procedures: It is appropriate to designate multiple procedures that are rendered on the same date by separate entries.