Determining Anesthesia Service Payments and Modifiers

As a new medical coder for an Anesthesiologist group, it is important that you practice calculating service payments by assigning the appropriate anesthesia code(s) and modifier(s), as well as determining the base and time unit values, any modifying circumstances, and the conversion factor to arrive at your anesthesia service payment.

Apply your knowledge of Anesthesia coding.

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Include the following aspects in the assignment:

Ø  Use the data in the tables below

Ø  Be creative and create two different scenarios

Ø  Time should be in 15 minute increments

Ø  Describe how to calculate anesthesia base and time units

Ø  Distinguish anesthesia service payments by using and describing the approved formula

Ø  Arrive at the correct reimbursement and coding responses for each scenario

Ø  Assign physical status and qualifying circumstance codes to your CPT anesthesia codes in each of the two scenarios.

Physical Status Modifiers

Physical Status Modifiers                    Relative Value

P1                                                                        0

P2                                                                        0

P3                                                                        1

P4                                                                        2

P5                                                                        3

Qualifying Circumstances

Qualifying Circumstances Code             Relative Value

99100                                                                  1

99116                                                                  5

99135                                                                  5

99140                                                                   2

Conversion Factors by Location

Locality Name                                        National Anes CF of 22.2730

ALABAMA                                                              21.20

ALASKA**                                                              30.99

ARIZONA                                                                21.95

ARKANSAS                                                            21.25

BAKERSFIELD, CA                                                 22.36

CHICO, CA                                                              22.29

EL CENTRO, CA                                                      22.30

FRESNO, CA                                                            22.29

HANFORD-CORCORAN, CA                                  22.30

Anesthesia Base Units by Anesthesia CPT Codes

CODE                    BASE UNITS                        CODE                            BASE UNITS

00100                             5                                  00539                                   18

00102                             6                                 00540                                    12

00103                             5                                  00600                                   10

00104                             4                                  00620                                   10

00120                             5                                  00625                                   13

00210                             11                                01960                                      5

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