Notification

Anesthesia Services for a Cancelled or Discontinued Procedure


Notification Issue Date: 09/17/2008

This is only a notification of the policy that will be in effect on 12/16/2008. For the current version of this policy, click the following link: 01.00.02a, Anesthesia Services for a Cancelled or Discontinued Procedure.



Claim Payment Policy


Title:Anesthesia Services for a Cancelled or Discontinued Procedure

Policy #:01.00.02b

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.

Application of Claim Payment Policy is determined by benefits and contracts. Benefits may vary based on product line, group or contract. Medical necessity determination applies only if the benefit exists and no contract exclusions are applicable. Individual member benefits must be verified.

In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

The Company covers and considers for reimbursement anesthesia services performed by an anesthesia provider in association with or prior to the cancellation or discontinuation of a covered procedure and reported as follows:
  • If the procedure is cancelled due to the assessment of the the patient's condition during the anesthesia provider's presurgical/preanesthetic evaluation and prior to induction of regional or general anesthesia, report the following:
    • An evaluation and management (E&M) code that reflects the type and level of service performed
      • The Company applies the applicable Current Procedural Terminology (CPT) E&M service reporting guidelines to all E&M (eg, consultation E&M) codes.
    • A description of and an indication that the procedure was cancelled or discontinued and either V64.1 or V64.3 as a secondary diagnosis to identify the surgical procedure that was cancelled or discontinued
  • If the procedure is cancelled following the anesthesia provider's presurgical/preanesthetic assessment and the patient's preparation for surgery, and before induction of regional or general anesthesia, report CPT code 01999 (unlisted anesthesia procedure[s]):
    • A description of and an indication that the procedure was cancelled or discontinued and either V64.1 or V64.3 as a secondary diagnosis to identify the surgical procedure that was cancelled or discontinued
      • The reporting of base units in association with CPT code 01999 is not required as the Company applies three base units in calculating reimbursement.
  • If the procedure is cancelled or discontinued after general or regional anesthesia induction has occurred, report the following:
    • The appropriate American Society of Anesthesiologists (ASA) code corresponding to the surgical procedure plus the time expended, in minutes, providing the anesthesia services
      • The reporting of base units in association with the ASA code is not required as the Company applies the ASA recommended base units for the ASA code in calculating the reimbursement.
      • If reimbursement for the ASA code is considered by the Company at a flat rate, time is not applied and should not be reported. Individual provider fee schedules apply.
ADDITIONAL BILLING REQUIREMENTS

Providers must report the following:
  • The primary diagnosis(es), and, as a secondary diagnosis, either V64.1 or V64.3 to identify that the procedure was cancelled or discontinued
  • A description of the procedure and an indication that the procedure was cancelled or discontinued
  • As applicable, the E&M code that most accurately represents the service performed when an E&M code is reported
    • The Company applies CPT E&M service reporting guidelines to all E&M (eg, consultation E&M) codes.
      • The E&M guidelines in the edition of the CPT Manual that is current on the date that the E&M service (eg, consultation) was performed are applied.
Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to, records from the physician's office, hospital, nursing home, home health agencies, therapies, other health care professionals, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request.

Guidelines

Preoperative consultations performed by providers in anesthesia specialties differ in scope and depth from the preanesthetic assessment of the surgical candidate. The preanesthetic assessment is routinely performed prior to anesthesia administration and surgery or prior to a nonsurgical procedure for which the services of an anesthesia provider is required.
  • Refer to the policy addressing preoperative consultations performed by providers in anesthesia specialties for additional information and requirements.
Providers in anesthesia specialties should not report Modifier 74 (discontinued outpatient hospital/ambulatory surgery center [ASC] procedure after administration of anesthesia) with anesthesia procedure codes (00100-01999). Modifier 74 does not identify a code as a cancelled or discontinued anesthesia service or an anesthesia service that was performed in association with a cancelled or discontinued procedure.

Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

MEDICARE

Although Medicare covers anesthesia services for a cancelled or discontinued procedure, claims received for anesthesia services for a cancelled or discontinued procedure for the Company's Medicare Advantage members are processed in accordance with this policy. The Company's payment methodology may differ from Medicare.

Description

There are times or situations when it is necessary to cancel or discontinue a procedure after the anesthesiologist and/or certified registered nurse anesthetist (CRNA) has rendered services associated with that procedure. These services may include, but are not limited to, the following:
  • Preanesthetic assessment of the patient
  • Prescription of an anesthetic agent(s)
  • Administration of an anesthetic agent(s)
  • Postoperative management of the patient
Evaluation and management (E&M) service codes represent the evaluation of an individual's medical condition and the medical management of that condition by a provider. Requirements for the reporting of these services are outlined in the American Medical Association's (AMA) Current Procedural Terminology (CPT) Manual, which is published annually.

As used in this policy, anesthesia provider refers only to providers in anesthesia specialties (ie, anesthesiologist, CRNA).

References


American Society of Anesthesiologists. 2008 Relative Value Guide™: A Guide for Anesthesia Values. Park Ridge, IL: ASA Press; 2007.

American Society of Anesthesiologists (ASA). ASA Annual Meeting Abstracts. Billing for preoperative anesthesia consultations for cancelled surgeries. (ASA Annual Meeting Abstracts Web site.) Available at: http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=2A371048FC3609B07E0A6462F740D9BC?year=2004&index=15&absnum=1404. Accessed August 22, 2008.

American Society of Anesthesiologists (ASA). Patient education Web site: Scope of practice. [ASA Web site]. Available at: http://www.asahq.org/patientEducation.htm#scope.Accessed August 22, 2008.

American Society of Anesthesiologists (ASA). Practice advisory for preanesthesia evaluation. A report by the ASA Task Force on preanesthesia evaluation. Original: February 2002. (Revised: 10/15/03). [ASA Web site]. Available at: http://www.asahq.org/publicationsAndServices/preeval.pdf. Accessed August 25, 2008.

Beebe M, Dalton JA, Espronceda M, Evans DD, Glenn RL, eds. Current Procedural Terminology: CPT® 2008. Appendix D. Chicago, IL: American Medical Association; 2008.

Beebe M. Principles of CPT®. 5th ed. Chicago, IL: American Medical Association; 2008.

Centers for Medicare & Medicaid Services (CMS). National Correct Coding Initiative (NCCI) Policy Manual for Part B Medicare Carriers. Chapter II, Version 13.3: Anesthsia services. [CMS Web site]. 12/07/07.
Available at:
http://www.cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp#TopOfPage (zip folder document: CHAP2final083107.doc). Accessed August 22, 2008.

Centers for Medicare & Medicaid Services (CMS). The Carriers Manual. Part 3, Chapter XVI: Fee schedule for physicians’ services. §15018. Payment conditions for anesthesiology services. [CMS Web site].November 2002. Available at: http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS021921&intNumPerPage=10. (zip folder document : b3_15000_to_15903.doc). Accessed August 22, 2008.


Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

01999


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Procedure Code Number(s)





Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Diagnosis Code Number(s)




HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References


Policy History

Effective 10/05/2017 this policy has been updated to the new policy template
format.
Version Effective Date: 12/16/2008
Version Issued Date: 12/16/2008
Version Reissued Date: N/A

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