Mich. Admin. Code R. 418.10915 - Billing for anesthesia services
Rule 915.
(1)
Anesthesia services shall consist of 2 components. The 2 components are base
units and time units. Each anesthesia procedure code is assigned a value for
reporting the base units. The base units for an anesthesia procedure shall be
as specified in the publication entitled "Medicare RBRVS: The Physicians'
Guide" as adopted by reference in
R 418.10107. The anesthesia codes,
base units, and instructions for billing the anesthesia service shall be
provided separate from these rules on the agencys website,
www.michigan.gov/wca.
(2) When billing for both the
anesthesiologist and a certified registered nurse anesthetist or a certified
anesthesiologist assistant, the anesthesia procedure code shall be listed on 2
lines of the CMS 1500 with the appropriate modifier on each line.
(3) One of the following modifiers shall be
added to the anesthesia procedure code to determine the appropriate payment for
the time units:
(a) Modifier -AA indicates
the anesthesia service is administered by the anesthesiologist.
(b) Modifier -QK indicates the
anesthesiologist has provided medical direction for not more than 4 qualified
individuals being a certified registered nurse anesthetist (CRNA),
certified anesthesiologist assistant (AA), or resident. The CRNA, AA, or
resident may be employed by a hospital, the anesthesiologist, or may be
self-employed.
(c) Modifier AD
indicates an anesthesiologist has provided medical supervision for more than 4
qualified individuals being either a certified registered nurse anesthetist,
certified anesthesiologist assistant, or anesthesiology resident.
(d) Modifier -QX indicates the certified
registered nurse anesthetist or certified anesthesiologist assistant has
administered the procedure under the medical direction of the
anesthesiologist.
(e) Modifier -QZ
indicates the certified registered nurse anesthetist has administered the
complete anesthesia service without medical direction of an
anesthesiologist.
(4)
Total anesthesia units shall be calculated by adding the anesthesia base units
to the anesthesia time units.
(5)
Anesthesia services may be administered by any of the following:
(a) A licensed doctor of dental
surgery.
(b) A licensed doctor of
medicine.
(c) A licensed doctor of
osteopathy.
(d) A licensed doctor
of podiatry.
(e) A certified
registered nurse anesthetist.
(f) A
licensed anesthesiology resident.
(g) A certified anesthesiologist
assistant.
(6) If a
surgeon provides the anesthesia service, the surgeon shall only be reimbursed
the base units for the anesthesia procedure.
(7) If a provider bills physical status
modifiers, then documentation shall be included with the bill to support the
additional risk factors. When billed, the physical status modifiers are
assigned unit values as defined in the following Anesthesiology Physical Status
Modifiers Unit Value table:
P1: A normal healthy patient = 0
P2: A patient who has a mild systemic disease = 0
P3: A patient who has a severe systemic disease = 1
P4: A patient who has a severe systemic disease that is a constant threat to life = 2
P5: A moribund patient who is expected not to survive without the operation = 3
P6: A declared brain-dead patient whose organs are being removed for donor purposes = 0
(8) Procedure code 99140 shall be billed as
an add-on procedure if an emergency condition, as defined in
R
418.10108, complicates anesthesia. Procedure code
99140 shall be assigned 2 anesthesia units. Documentation supporting the
emergency shall be attached to the bill.
(9) If a pre-anesthesia evaluation is
performed and surgery is not subsequently performed, then the service shall be
reported as an evaluation and management service.
Notes
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