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Anesthesia & Pain Management

Anesthesia is the administration of a drug or gas to induce partial or complete loss of consciousness. Services involving administration of anesthesia should be reported by the use of the Current Procedural Terminology (CPT) anesthesia five-digit procedure code plus modifier codes. Surgery codes are not appropriate unless the anesthesiologist or Qualified Nonphysician Anesthetist is performing the surgical procedure.

Anesthesia services include (but not limited to) local, general or regional

  • By a physician/anesthesiologist
    • Under medical supervision of a physician
  • Certified Registered Nurse Anesthetist (CRNA) or Anesthesia Assistants (AA) may also provide services
    • Locum tenens do not apply to CRNA / AA

General Anesthesia Guidelines

  • Services include
    • Pre/post-operative visits
    • Anesthesia care during the procedure
    • Administration of fluids and/or blood
    • Usual monitoring services
      • E.g., ECG, temperature, blood pressure, oximetry, capnographyand mass spectrometry
  • Separate/multiple anesthesia procedures performed during single anesthetic administration
    • Most complex procedure reported
    • Combine time for all procedures
  • Epidural injections/other forms of nerve blockade reimbursed (as part of anesthetic management), when used as primary anesthesia route or obstetrical analgesia

For anesthesia services guidance go to the CMS Anesthesiologists Center This link takes you to an external website.. It contains links on the following:

  • Billing/Payment – Anesthesia Conversion Factors, Base Units by CPT
  • Participation – Public Health
  • Issues on Anesthesia – Physician Regulatory Issues Team (PRIT)
  • Helpful Links – American Society of Anesthesiologists, American Association of Nurse Anesthetists, Related Organizations
  • CMS Manuals & Transmittals – Internet Only Manual (IOM), Transmittals, NCCI,
  • Educational Resources – MLN general information, web guides, products, articles
  • Contacts – CMS Regional Office
  • How to Stay Informed – Sign up for emails, Press Releases, Open Door Forums
Specialty Brief Description
Certified Registered Nurse Anesthetist (CRNA) A Nurse Anesthetist, or Certified Registered Nurse Anesthetist (CRNA), is a licensed professional nurse who provides the same anesthesia services as an anesthesiologist (MD). After completing extensive education and training, CRNAs become nationally certified.
Anesthesiology Assistant An Anesthesia Assistant (AA) is a specially trained, health professional who participates in the care of the stable surgical patient during general, regional, or conscious sedation anesthesia through medical directives under the supervision of the anesthesiologist.
Teaching Anesthesiologist If a teaching anesthesiologist is involved in a single procedure with one resident, the anesthesia services will be paid at the personally performed rate. The teaching physician must document in the medical records that he/she was present during all critical (or key) portions of the procedure.
Anesthesia Procedure Codes If the surgery is non-covered, the anesthesia is also non-covered.  View the table of anesthesia procedure codes.

 

Resources

Last Updated Jul 15, 2015