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MP 10.01.06

Anesthesia Services


 

 

Medical Policy    
Section
Administrative
Original Policy Date
5/30/97
Last Review Status/Date
Reviewed by consensus/4:2003
Issue
4:2003
  Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.

 


 

Description

Anesthesia services consist of the administration of an anesthetic agent in one of the following types of anesthesia:

 

1. General anesthesia—loss of ability to perceive pain associated with loss of consciousness produced by intravenous infusion of drugs or inhalation of anesthetic agents.

 

2. Regional anesthesia—use of local anesthetic solution(s) to produce circumscribed areas of loss of sensation. This includes nerve block, spinal, epidural, and field block. Local infiltration or topical application of an anesthetic into or onto the operative site is local, rather than regional, anesthesia. Epidural anesthesia is produced by injection of local anesthetic solution into the peridural space.

 


 

Policy

General, regional and epidural anesthesia services are medically necessary when these services are provided as part of a covered surgical or obstetrical procedure.


 

 

Policy Guidelines

The following components are considered an integral part of the anesthesia service and additional benefits are not provided:

  • Pre-anesthesia evaluation;
  • Postoperative visits;
  • Anesthetic or analgesic administration;
  • All necessary monitoring;
  • Intraoperative administration of drugs, I.V. fluids, blood, etc., and
  • Services administered in recovery room.

Monitoring of IV sedation by an anesthesiologist for gastrointestional endoscopy, arteriograms, CT scans, MRIs, cardiac catherizations, and PTCA is generally considered not medically necessary except for children, acutely agitated patients, or, in some cases, for acutely ill patients who cannot have the procedure without sedation. Exceptions may be made for CT scans and MRIs for agitated patients. Examples include but are not limited to patients with: organic brain disease, senile dementia, delirium, claustrophobia, or uncooperative mentally retarded patients. In the case of cardiac catherization and PTCA, the catherization lab setting provides monitoring availability. Any monitoring not done by the attending cardiologist is done by hospital personnel and separate benefits are not provided.

 


 

 

Benefit Application

BlueCard/National Account Issues

The period of time on which anesthesia time units are based begins when the anesthesiologist is first in attendance with the patient for the purpose of induction of anesthesia, and ends when the patient leaves the operating room or delivery room. Time spent in the recovery room is included in the anesthesia base units and no additional benefits are provided.

Local anesthesia is considered to be an integral part of the surgical procedure and no additional benefits are provided.

The base value for anesthesia when multiple surgical procedures are performed is the base value for the procedure with the highest relative unit value. No benefits are provided for the base unit values of additional procedures. Time units cover the additional time required for these procedures.

Standby anesthesia services are not eligible for coverage even when required by the facility in which the patient is to have surgery. Anesthesia attendance including provision of anesthesia and all patient monitoring is eligible for coverage. For a procedure to be considered anesthesia attendance and not standby, all of the following must occur:
The service is requested by the attending physician;
The anesthesiologist documented that he/she was present for the entire procedure and provided all the usual services, except actual administration of anesthetic agent; and
Anesthesia attendance must be medically necessary for the patient’s surgical procedure and condition.

A pre-anesthesia evaluation by the anesthesiologist when surgery is canceled may be covered at the level of care rendered (e.g., brief or limited visit) as a hospital or office visit.

A pre-anesthesia evaluation by the anesthesiologist when the procedure is delayed is not eligible for coverage as a separate procedure. It is an integral part of the subsequent anesthesia services.
If an organ or tissue transplant is eligible for payment, the anesthesia services for harvesting the organ or tissue from a cadaver donor is also covered (maintaining respiration, oxygenation, etc.). Harvesting of organs or tissues requires careful maintenance of the donors to retain organ viability. However, base relative value and time units only are allowed, with no additional modifying units.

Supervision by an anesthesiologist of a nurse anesthetist or a physician-in-training is limited to no more than 4 procedures performed concurrently. An anesthesiologist having such an obligation should not actually be administering anesthesia.

Spinal manipulation under anesthesia is not eligible for coverage.

There may be local variations in method of payments regarding anesthesia services.

 


 

Rationale

The data compiled for this policy was a combination of standard billing practices, local plan policies and claims experience.

See also:

AMerican Medical Association's Physician's Current Procedural Terminology (CPT)

Patient Controlled ANalgesia, policy No. 10.01.07

 

Codes

Number

Description

CPT  00100, 00102, 00103, 00104, 00120, 00124, 00126, 00140, 00142, 00144, 00145, 00147, 00148, 00160, 00162, 00164, 00170, 00172, 00174, 00176, 00190, 00192, 00210, 00212, 00214, 00215, 00216, 00218, 00220, 00222, 00300, 00320, 00322, 00326, 00350, 00352, 00400, 00402, 00404, 00406, 00410, 00450, 00452, 00454, 00470, 00472, 00474, 00500, 00520, 00522, 00524, 00528, 00529, 00530, 00532, 00534, 00537, 00539, 00540, 00541, 00542, 00546, 00548, 00550, 00560, 00561, 00562, 00563, 00566, 00580, 00600, 00604, 00620, 00622, 00625, 00626, 00630, 00632, 00634, 00635, 00640, 00670, 00700, 00702, 00730, 00740, 00750, 00752, 00754, 00756, 00770, 00790, 00792, 00794, 00796, 00797, 00800, 00802, 00810, 00820, 00830, 00832, 00834, 00836, 00840, 00842, 00844, 00846, 00848, 00851, 00860, 00862, 00864, 00865, 00866, 00868, 00870, 00872, 00873, 00880, 00882, 00902, 00904, 00906, 00908, 00910, 00912, 00914, 00916, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00932, 00934, 00936, 00938, 00940, 00942, 00944, 00948, 00950, 00952, 01112, 01120, 01130, 01140, 01150, 01160, 01170, 01173, 01180, 01190, 01200, 01202, 01210, 01212, 01214, 01215, 01220, 01230, 01232, 01234, 01250, 01260, 01270, 01272, 01274, 01320, 01340, 01360, 01380, 01382, 01390, 01392, 01400, 01402, 01404, 01420, 01430, 01432, 01440, 01442, 01444, 01462, 01464, 01470, 01472, 01474, 01480, 01482, 01484, 01486, 01490, 01500, 01502, 01520, 01522, 01610, 01620, 01622, 01630, 01632, 01634, 01636, 01638, 01650, 01652, 01654, 01656, 01670, 01680, 01682, 01710, 01712, 01714, 01716, 01730, 01732, 01740, 01742, 01744, 01756, 01758, 01760, 01770, 01772, 01780, 01782, 01810, 01820, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01860 Anesthesia services (for procedures on the various body systems, including spine and spinal cord)
  01960-01969 Obstetric anesthesia code range
  01995 Regional IV administration of local anesthetic agent
ICD-9 Procedure  No Code   
ICD-9 Diagnosis  No Code   
HCPCS  No code  
Type of Service  Medical 
Place of Service 

Inpatient

Outpatient

Free-standing Facility

Physician's Office

 


 

Index

Anesthesia services
Epidural anesthesia
General anesthesia
Local anesthesia
Modifying units, anesthesia services
Nurse anesthetists
Regional anesthesia
Standby anesthesia

 


 

Policy History

Date Action Reason
05/03/97 Add to Administrative section New policy
04/15/02 Replace policy Policy reviewed without literatur review; new review date only
12/17/03 Replace policy Policy reviewed by consensus without literature review; no changes in policy other than CPT codes updated; no further review scheduled.