Anesthesia Modifiers - P1 - P6 modifier

Anesthesia Modifiers Including Physical Status Modifiers:

All anesthesia services are reported by use of the anesthesia five-digit procedure code (00100-01999) plus the addition of a physical status modifier. The use of other optional modifiers may be appropriate.

Physical Status Modifiers

Physical Status modifiers are represented by the initial letter 'P' followed by a single digit from 1 to 6

defined below:

P1 - A normal healthy patient.

P2 - A patient with mild systemic disease.

P3 - A patient with severe systemic disease.

P4 - A patient with severe systemic disease that is a constant threat to life.

P5 - A moribund patient who is not expected to survive without the operation.

P6 - A declared brain-dead patient whose organs are being removed for donor purposes.

The above six levels are consistent with the American Society of Anesthesiologists (ASA) ranking of patient physical status. Physical status is included in CPT to distinguish between various levels of

complexity of the anesthesia service provided.

Example: 00100-P1

Other Modifiers (Optional)

Under certain circumstances, medical services and procedures may need to be further modified. Other

modifiers commonly used in Anesthesia are included below. A complete list of modifiers and their

respective codes are listed in Appendix A.

-22 Unusual Procedural Services: When the service(s) provided is greater than that usually

required for the listed procedure, it may be identified by adding modifier '-22' to the usual procedure

number or by use of the separate five digit modifier code 09922. A report may also be appropriate.

-23 Unusual Anesthesia: Occasionally, a procedure which usually requires either no anesthesia or

local anesthesia, because of unusual circumstances must be done under general anesthesia. This

circumstance may be reported by adding the modifier '-23' to the procedure code of the basic service

or by use of the separate five digit modifier code 09923. Note: Modifier '-47', Anesthesia by

Surgeon, (see modifier section) would not be used as a modifier for the anesthesia procedures 00100-

01999.

-32 Mandated Services: Services related to mandated consultation and/or related services (eg,

PRO, 3rd party payer) may be identified by adding the modifier '-32' to the basic procedure, or the

service may be reported by use of the five digit modifier 09932.

Anesthesia billing services - BCBS

Anesthesia Payment & Billing Information - BCBS

Time and Points Eligible Anesthesia Procedures Defined

HMO Blue Texas and Blue Cross and Blue Shield of Texas have determined that certain anesthesia procedures will be reimbursed on time and points methodology.

Procedures that are not included on the Anesthesia Time & Points Eligible List will not be reimbursed using time and points methodology. If a procedure is not on this list, and it is submitted using anesthesia indicators for Time & Points such as:

using an anesthesia modifier, or

using time on the claim, or

 if submitted on a non-HIPAA claim format, (Type of Service = 7) then the provider may receive a denial message for that procedure noting that the service is not eligible for time and points payment methodology.

Anesthesia Services

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.

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

BCBS - Anesthesia Modifier reimbursement

Anesthesia Payment & Billing Information - BCBS

Anesthesia Modifier Reimbursement :

Effective for dates of service on or after May 19, 2004, the HMO Blue Texas and Blue Cross and Blue Shield of Texas maximum allowable fees for services billed as MD supervision of a CRNA are as follows:

QY MD supervision of a CRNA $325.52

QK MD supervision of a CRNA $310.01

AD MD supervision of a CRNA $162.76

OB Time and Points Maximum Allowable Points : 

The following are the current HMO Blue Texas and Blue Cross and Blue Shield of Texas total maximum allowable points for Vaginal or Cesarean deliveries:

Obstetrical Vaginal delivery: 23 total maximum allowable points

Obstetrical Cesarean delivery: 32 total maximum allowable points

If general anesthesia is used in the performance of any obstetrical Vaginal or Cesarean delivery, the maximum allowable points are applicable. In the event that total actual points are less than the total maximum allowable points, you will be reimbursed based on total actual points.

Reimbursement of OB Anesthesia Add-On Codes 01968 and 01969 :

When a primary OB delivery anesthesia procedure (01967) is billed with either 01968 and/or 01969, HMO Blue Texas and Blue Cross and Blue Shield of Texas allows a combined maximum of 32 points.

Aneshthesia Time-Based Units

During the first 4 hours of service, 15 minutes equals 1 unit. If services are provided for longer than 4 hours in one occurrence, each 10-minute period after the initial 4 hours equals 1 unit. A period less than a unit should be rounded up to the next unit.

Example A: 5 hours or 300 minutes equals 22 units – 16 units for the first 4 hours (1 unit per each 15 minutes) and 6 units for the last hour

(1 unit per each 10 minutes).

Example B: 128 minutes is billed as 9 units (8 units for the first 120 minutes and 1 additional unit for the remaining 8 minutes).

Completing the Claim Form

The following instructions are specific to anesthesia services and must be used in conjunction with the complete CMS-1500 Claim Form Instructions provided on First Health Services’ website (select “Billing Information” from the “Providers” menu).

· Field 19: When billing a time-based code, enter the total minutes of reportable anesthesia time in Field 19.

· Field 24D: On the bottom, white half of the claim line, enter one CPT code and one physical status modifier (P1-P6). List additional modifiers when appropriate.

· Field 24G:

o When using a time-based code, enter the number of reportable anesthesia time units; do not add base units or modifier units to the time units.

o When using an occurrence-based code, enter a “1” for each occurrence. The following codes are paid per occurrence: 01953, 01967, 01968, 01969, 01996, 99100, 99116, 99135 and 99140.

Anethesia billing - Introduction

Anesthesia care conventionally includes all services associated with the administration of analgesia/anesthesia, provided by an anesthesiologist and/or certified registered nurse anesthetist (CRNA)1 to a patient undergoing a surgical or other invasive procedure so that intervention can be undertaken. This may involve local, regional, epidural, general anesthesia or monitored anesthesia care (MAC), and usually involves administration of anxiolytics or amnesia-inducing medications. 

Additionally, anesthesia care includes preoperatively evaluating the patient with a sufficient history and physical examination so that the risk of adverse reactions can be minimized, planning alternative approaches to accomplishing anesthesia and answering all questions regarding the anesthesia procedure asked by the patient.

The anesthesiologist assumes responsibility for the post anesthesia recovery period which is included in the anesthesia care package. It encompasses all care until the patient is released to the surgeon or another physician; this point of release generally occurs at the time of release from the post anesthesia recovery area.