Anaesthesia Billing Codes: A Combination Of Modifiers, Add-On Codes And Conversion Factors

Published on March 1, 2019 By , 0 Categorised in:

Anaesthesia is a form of a specialized medical treatment that involves the infusion of a medicated drug or a gas, in a patient, with the purpose of partial or complete loss of consciousness. The services related to the use of anaesthesia has to be informed by the Current Procedural Terminology or CPT. The anesthesia billing codes deal with the administration of anaesthesia with a five-digit procedure code and modifier codes.

The codes for surgery become inappropriate unless and until an anaesthesiologist or a qualified non- physician anaesthetist performs the surgery as only these three are preferred to provide anaesthesia. In such cases they have the right to bill the insurance company of the patient for their services.

The role of modifiers is important in the anaesthesia billing codes. They are a two-position alpha or numerical codes adjoined to a CPT code for mentioning the services offered, clearly in the bill. Modifiers helps to modify some services without any change in the procedure code. They increase the efficiency and reliability in the process of reimbursement, bring consistency in coding and align payment data.

The anaesthesia given to patients must adhere to one of the following HCPCS modifiers-

  • AA: It includes the anaesthesia services performed directly by an anaesthesiologist or during the assistance of an anaesthetist provided to a physician for a single patient.
  • QY: It includes the medical direction given by any one qualified non-physician.
  • QK: It includes the medical direction of two, three or four concurrent anaesthesia procedures with the help of qualified professionals.
  • AD: It includes the medical supervision of a physician for more than four concurrent anaesthesia procedures.
  • QX: It includes services of a qualified non-physician anaesthetist under the medical supervision of a physician.
  • QZ: It includes althe services of a qualified non-physician anaesthetist service without the help of a physician.
  • QS: It includes monitored anaesthesia care services that are eligible for billing by a qualified non-physician anaesthetist, or a physician.

The insurance carriers maintain a record documentation wherein the insured has to submit a detailed report mentioning the names of the anaesthetists that were administered and different procedures performed by professionals for selected claims. When a physician fails to supply the aforementioned data and the necessary documents, they might be eligible for a pre-payment or post-payment auditing.

The anesthesia billing specialists, provides charge-capture assistance on a daily basis for anaesthesia procedures. They create and present the research documentation and cater to the needs of coding and billing. The specialist isnot limited to charge-capture, billing enhancement opportunities, inquiries and compliance regulations; they are also the in-charge for management and response against the several queries related to charge-capture. They also prepare reports on outstation and missing patients.

These specialists research, investigate and prepare final reports on rejected claims and works on the issuance of denial. They work on each and every account in the practice management system for the generation of accurate bills. They follow up with the payment procedures, delayed payments by the insurance companies, underpayments and violation of contractual agreements. The anaesthesia specialists also sort and review the necessary paperwork’s to handle anaesthesia billing procedures.

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