Anesthesia Medical billing guidelines

Aug 26, 2009 | Medical billing basics | 2 comments

1. No need to enter the base units in HCFA
2. Time units are calculated in 15-minute increments. For ex 0 – 15 min will be consider as 1 unit and 16 – 30 Min will be consider as 2 Unit and so on.
3. Need to enter the anesthesia timings; it should be printed in online comment.
4. Insurance will calculated the unit as by using (Base unit + Modifying unit +Time unit = Total Units)
5. Modifying unit will be
Modifier – Description – unit Value
P1 – Normal health Patient – 0
P2 – Patient with mild systemic disease – 0
P3 – Patient with severe systemic disease – 1
P4 – Patient with severe systemic disease that is a constant threat to life – 2
P5 – Moribund Patient not expected to survive w/out operation – 3
6. Time value has to printed in the box 19 or as claim note. For

exTime :12.10 – 12.55 (45 Min)
7. If anesthesia given two time use ZG Modifier.
8. EMC file has to go with Miniutes instead of units which is we are using on regular billing. See the next point
9.we need to mention in 2400 loop segment SV1 03 MJ (Minutes) SV 04 number of minutes.
10. Payment will be calculated as (Base Units + Time Units) x Participating Conversion Factor.
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2 Comments

  2. Affordable Medical Coding and Billing Training
    Affordable Medical Coding and Billing Training on September 7, 2009 at 12:28 pm

    Also Refer HCPCS Modifiers for Anesthesia.

    HIPAA HL7