ANESTHESIA

CPT Code Base Unit Value

00100 $255.95 + TM*

00400 $153.57 + TM*

00632 $358.33 + TM*

00102 $307.14 + TM*

00402 $255.95 + TM*

00634 $511.90 + TM*

00103 $255.95 + TM*

 00404 $255.95 + TM*

 00635 $204.76 + TM*

00104 $204.76 + TM*

00406 $665.47 + TM*

00640 $153.57 + TM*

00120 $255.95 + TM*

00410 $204.76 + TM*

00670 $665.47 + TM*

00124 $204.76 + TM*

00474 $665.47 + TM*

00752 $307.14 + TM*

00126 $204.76 + TM*

00500 $767.85 + TM*

00754 $358.33 + TM*

00140 $255.95 + TM*

00520 $307.14 + TM*

00756 $358.33 + TM*

00142 $204.76 + TM*

00522 $204.76 + TM*

 00770 $767.85 + TM*

00144 $307.14 + TM*

00524 $204.76 + TM*

00790 $358.33 + TM*

00145 $307.14 + TM*

00528 $409.52 + TM*

00792 $665.47 + TM*

00147 $204.76 + TM*

00529 $563.09 + TM*

00794 $409.52 + TM*

00148 $204.76 + TM*

00530 $204.76 + TM*

00796 $1535.70 + TM*

00160 $255.95 + TM*

00532 $204.76 + TM*

00797 $563.09 + TM*

00162 $358.33 + TM*

00534 $358.33 + TM*

00800 $204.76 + TM*

00164 $204.76 + TM*

 00537 $358.33 + TM*

00802 $255.95 + TM*

00170 $255.95 + TM*

00539 $921.42 + TM*

00810 $255.95 + TM*

00172 $307.14 + TM*

00540 $614.28 + TM*

 00820 $255.95 + TM*

00174 $307.14 + TM*

00541 $767.85 + TM*

00830 $204.76 + TM*

00176 $358.33 + TM*

00542 $767.85 + TM*

00832 $307.14 + TM*

00190 $255.95 + TM*

00546 $767.85 + TM*

00834 $255.95 + TM*

00192 $358.33 + TM*

00548 $870.23 + TM*

00836 $307.14 + TM*

 00210 $563.09 + TM*

00550 $511.90 + TM*

00840 $307.14 + TM*

00211 $511.90 + TM*

00560 $767.85 + TM*

00842 $204.76 + TM*

00212 $255.95 + TM*

00561 $1279.75 + TM*

00844 $358.33 + TM*

00214 $460.71 + TM*

00562 $1023.80 + TM*

00846 $409.52 + TM*

00215 $460.71 + TM*

00563 $1279.75 + TM*

00848 $409.52 + TM*

00216 $767.85 + TM*

00566 $1279.75 + TM*

00851 $307.14 + TM*

00218 $665.47 + TM*

00567 $921.42 + TM*

00860 $307.14 + TM*

00220 $511.90 + TM*

00580 $1023.80 + TM*

00862 $358.33 + TM*

00222 $307.14 + TM*

00600 $511.90 + TM*

00864 $409.52 + TM*

00300 $255.95 + TM*

00604 $665.47 + TM*

00865 $358.33 + TM*

00320 $307.14 + TM*

00620 $511.90 + TM*

00866 $511.90 + TM*

00322 $153.57 + TM*

 00622 $665.47 + TM*

00868 $511.90 + TM*

00326 $358.33 + TM*

00625 $665.47 + TM*

00870 $255.95 + TM*

00350 $511.90 + TM*

00626 $767.85 + TM*

00872 $358.33 + TM*

00352 $255.95 + TM*

00630 $409.52 + TM*

00873 $255.95 + TM*

00880 $767.85 + TM*

01212 $511.90 + TM*

01610 $255.95 + TM*

00882 $511.90 + TM*

01215 $511.90 + TM*

01622 $204.76 + TM*

00902 $255.95 + TM*

01220 $204.76 + TM*

01630 $255.95 + TM*

00904 $358.33 + TM*

01230 $307.14 + TM*

01634 $460.71 + TM*

00906 $204.76 + TM*

01232 $255.95 + TM*

01636 $767.85 + TM*

00918 $255.95 + TM*

COST CONTAINMENT

Nothing in this section shall preclude an employer (or insurance carrier) from entering into payment agreements to promote the continuity of care and the reduction of health care costs. Such payment agreements, if less, will supersede the limitation amounts specified herein. Please refer to K.S.A 44-510i(e) for further clarification, if necessary.

NATIONAL CORRECT CODING INITIATIVE (NCCI) EDITS: In order to promote correct coding methodologies and to control improper coding leading to inappropriate payments, the Kansas Division of Workers Compensation Schedule of Medical Fees recognizes the 2014 National Correct Coding Initiatives (NCCI) Edits as established by the Centers for Medicare and Medicaid Services (CMS) as the primary standard of reference. The NCCI Edits are not requirements, nor are they mandates or standards; they simply provide advice for correct coding methodologies. Bills must be itemized by procedure code, date of service, and amount of charge.  

CALCULATION EXAMPLES:

1: In a procedure with a Basic Unit Value of 3.0 requiring one hour and forty-five minutes of anesthesia time, the total value should be determined as follows: 

 Basic Unit Value = 3.0 units 

 105 minutes÷15 minutes = 7.0 units 

 Total value = 10.0 units 

2: In a procedure with a Basic Unit Value of 10.0 requiring four hours and twenty minutes of anesthesia time, the total value should be determined as follows:

Basic Unit Value = 10.0 units 

 First three hours = 12.0 units 

 Subsequent 80 minutes = 8.0 units 

 Total value = 30.0 units 

SUPPLEMENTAL SKILLS

When warranted by the necessity of supplemental skills, values for the services of two or more health care providers and/or anesthetists will be allowed. Substantiate by report.

MONITORING SERVICES: When an anesthesiologist or anesthetist is required to participate in and be responsible for monitoring the general care of the patient during a surgical procedure but does not administer anesthesia, these services are charged on the basis of the extent of the services rendered. Payment is to be made on the basis of the time units the anesthesiologist or anesthetist is in constant attendance for the sole purpose of the monitoring services; therefore, basic unit values are not to be added.  

ANESTHESIA ADMINISTERED, OTHER THAN BY AN ANESTHESIOLOGIST OR ANESTHETIST: Anesthesia fees are not payable when local infiltration, digital block, or topical anesthesia is administered by the operating surgeon or surgical assistants. Such services are included in the Unit Value for the surgical procedure. 

OTHER FEES: The Unit Values for surgery, x-rays, laboratory procedures, consultation and other medical services, and office and hospital visits are listed in the following sections: Surgery, Radiology, Pathology and Laboratory, Medicine, Physical Medicine and Rehabilitation, and Evaluation and Management. A consultation fee is not payable to an anesthesiologist examining the patient prior to administering anesthesia to that patient. No additional charge is to be made for routine follow-up care and observation. 

QUALIFYING CIRCUMSTANCES (more than one may be reported): Many anesthesia services are provided under particularly difficult circumstances depending on factors such as the extraordinary condition of the patient, notable operative conditions, unusual risk factors. This section includes a list of important qualifying circumstances that significantly impact on the character of the anesthetic service provided. These procedures would not be reported alone but would be reported as additional procedure numbers qualifying an anesthesia procedure or service. These modifying units may be added to the basic unit values. 

ANESTHESIA MODIFIERS

All anesthesia services are reported by use of the anesthesia five-digit procedure code plus the addition of a physical status modifier. These modifying units may be added to the basic unit value. The use of other optional modifiers may also be appropriate.

Physical Status Modifiers 

Physical status modifiers are represented by the initial letter P followed by a single digit from 1 to 6 as defined below:  

P1 - A normal healthy patient .................................................................................................. 0 

P2 - A patient with mild systemic disease .................................................................................. 0 

P3 - A patient with severe systemic disease ............................................................................... 1 

P4 - A patient with severe systemic disease that is a constant threat to life ............................... 2 

P5 - A moribund patient who is not expected to survive without the operation .......................... 3

P6 - A declared brain-dead patient whose organs are being removed for donor purposes ....................................................................................................................................................... 0 

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.

TIME UNITS (TM): TIME UNITS WILL BE ADDED TO THE BASIC UNIT VALUE AND MODIFYING UNITS AS IS CUSTOMARY IN THE LOCAL AREA. Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia care in the operating room or in an equivalent area, and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under other post-anesthesia supervision. 

The time units are calculated by allowing one unit for each 15 minutes or significant fraction thereof (7.5 minutes or more) of anesthesia time. If anesthesia time extends beyond three hours, 1.0 unit for each 10 minutes or significant fraction thereof (5 minutes or more) is allowed after the first three hours. Documentation of actual anesthesia time may be required, such as a copy of the anesthesia record in the hospital file.  

UNLISTED SERVICE OR PROCEDURE: When an unlisted service or procedure is performed, the values used should be substantiated "By Special Report." For an unlisted service or procedure, the health care provider or anesthetist shall establish a unit value consistent with other unit values listed in the schedule. 

MATERIALS SUPPLIED BY HEALTH CARE PROVIDER: Supplies and materials provided by the health care provider or anesthetist (e.g., sterile trays, drugs) over and above those usually included with the office visit or other services rendered may be listed separately. The statement of charges will need to reflect any drugs, trays, supplies, and materials that were provided. Payment shall not exceed the cost of the item(s) to the health care provider plus 25%, or the cost of the item(s) plus $15.00 per item, whichever is less. Use procedure code 99070

MODIFIER EXAMPLES

1: A physician providing diagnostic or therapeutic radiology services, ultrasound, or nuclear medicine services in a hospital would use modifier -26 to report the professional component, as follows:

 73090-26 = Professional component only for an x-ray of the forearm 

2: Two surgeons, usually with different skills, may be required to manage a specific surgical problem. The modifier -62 would be applicable. Modifier -62 would be appropriate only when both surgeons are reporting the same code number and descriptor. For instance, a neurological surgeon and an otolaryngologist are working as cosurgeons in performing transsphenoidal excision of a pituitary neoplasm. The first surgeon would report: 

61548-62 = Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic + two surgeons modifier AND the second surgeon would report: 

61548-62 = Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic + two surgeons modifier 

ANESTHESIA GROUND RULES

GENERAL: All anesthesia values are determined by taking the BASIC UNIT VALUE, which is related to the complexity of the service, and adding MODIFYING UNITS (if any), and TIME UNITS. The fee for a particular procedure or service in this section is determined by multiplying the listed "Basic Unit Value" by the conversion factor that is applicable to this section. . 

The values contained within this section apply when the anesthesia care is provided by or under the medical supervision of qualified physician. This anesthesia care may include but is not limited to general, regional, monitored anesthesia care, supplementation of local anesthesia, or other supportive services in order to afford the patient the anesthesia care deemed optimal. For anesthesia care provided by nurse anesthetists, billing for independent unsupervised services, payment will be limited to 85% of the maximum allowable fee associated with the CPT code submitted.