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Back  RFI # 1023: 837P Anesth Billing requiremen

Formal vs. Informal Help Informal Formal

Submitter

les orr

Description

We are seeking clarity on HIPAA requirements related to billing anesthesia services. Per the HC codeset for professional procedure codes, reported in SV101-2, can anesthesia services be billed by sending a surgical procedure code, and an anesthesia modifier in SV101-3? Or must anesthesia services be billed only with anesthesia procedure codes, 00100-001999? Is this detail specified in the codeset? Bottom-line, are both types of billing acceptable? Is it different for 4010 versus 5010?

Submitter Assigned Keywords

anesthesia services

Response

The SV101-2 is the procedure code for the service being reported on a particular service line and the SV101–3 is a procedure modifier for the procedure identified in the SV101-2. The note in the SV101–3 indicates that the procedure modifier “identifies special circumstances related to the performance of the service”.

In 005010, an HI Segment “Anesthesia Related Procedure” was added to allow reporting of the surgical procedure code related to the anesthesia services being billed when the conditions of the situational rule are met.
Submission 4/14/2010
Status Date 5/21/2010
Status F - Final
Primary References
Document 005010X222
Sectiondetail
Page352
Set ID1
Loop2400
Segment Positionsv101