Guidelines and Criteria:MSP begins your billable time when you first enter the operating room for the purpose of providing anaesthetic. Your time ends when you leave and when the patient can be safely left in the care of nursing staff. While you are working, you should calculate your time in 15 minute increments or parts thereof - for example, if your final period of anaesthetic is 9 minutes, you would be able to bill for the full 15. Other guidelines to keep in mind include: Routine P.A.R (Post-Anesthetic Recovery) care Any time you spend with the patient after your anaesthetic in the P.A.R for routine problems should be billed at the same rate as the anesthetic and included in the procedural fee for the anaesthesia. Additional Procedures When you perform more than one surgical, diagnostic, or therapeutic procedure during the same session, the rate for your total anaesthetic time will be the rate for whichever procedure has the highest procedural rate. Anaesthetic Procedural Fees The procedural fee for your anaesthesia time covers all of the services you’ll render during the procedure, except for the anaesthetic procedural fee modifiers and acute pain management. It is calculated by multiplying the intensity/complexity level of the anaesthesia by the anesthetic time per 15 minute interval. Anaesthetic Procedural Fee Modifiers These modifiers pay you an additional amount over and above your anesthetic procedural fee. They apply to all of your general, regional, and monitored anesthetic care for any surgical, therapeutic, and/or diagnostic procedures you might perform. You cannot use them with diagnostic or therapeutic anaesthesiology fees. Keep in mind that some modifiers may require additional information. For example, when billing the modifier code 00169, your claim must include a note indicating the patient’s body mass index (eg. BMI 35.5) Consultations and Anaesthetic Assessments These are not payable in addition to critical care fees. However, if they are done prior to surgery (for example, if you see a patient a week before a procedure to consult with them on their surgical risk) then you would be able to bill for this. Consultations are allowed once per 6-month period. All types of consultations (as outlined below) need to have been referred to you by a physician or nurse practitioner.
|Consultation||Full medical history required, must be referred to you by another physician or nurse practitioner.||Once per 6 month period|
|Repeat Consultation||Full medical history required, must pertain to different medical issue than previous consultation. Must be referred to you by another physician or nurse practitioner.||Once per 30 day period, but only for a completely different medical issue|
|Limited Consultation||Full medical history not required. Must be referred to you by another physician or nurse practitioner.||Once per 30 day period,|
|Complete Examination||Full medical history required; less time spent with the patient than a consultation. Does not require a referral and can be both a scheduled appointment or emergency visit.||Once every 12 month period (if you need to bill this twice for a patient within 12 months you need to have a note explaining why).|
Common Fee Codes:Here’s an overview of some of the most commonly used codes: Pre-Anesthetic Evaluation Fees: 01151: Pre-anaesthetic evaluation - standard
- Applicable to certified anesthesiologists only.
- Used for in-patient visits where a separate visit prior to the anaesthetic is required. If you’re performing a visit immediately prior to the anaesthetic, it will be paid using the anaesthetic intensity/complexity level of the procedure itself and 01151 - this code will not be paid in addition.
- Can also be used for out-patient visits where a separate visit for an anaesthetic assessment is required (such as in a pre-anesthetic clinic).
Consultations:01015: Consultation, anaesthesia
- This code is used when a certified anaesthesiology specialist is requested for a patient assessment because of the complexity, obscurity, and/or seriousness of the case.
- This is used when a repeat consultation is necessary for the same condition within six months and done by the same consultant.
- It is also used for a limited consultation when in the opinion of the consultant the problem does not warrant 01015.
- This code is used in consultations for complex diagnostic and/or therapeutic chronic pain management problems that need a comprehensive history and a physical examination.
- Used when, in the opinion of the consultant, the diagnostic and/or therapeutic chronic pain management problem is of a more limited nature.
- If the same physician sees a patient for a consultation within six months of billing 01016 for the same problem, then they would also use this code.
- This fee code applies to patient visits conducted in a private office setting where the physician has an increased overhead.
- This is used for telehealth sessions conducted by a certified specialist in Anesthesiology because of the complexity, obscurity and/or seriousness of the case. Includes appropriate history and an appropriate physical examination, as well as a review of pertinent radiological and laboratory findings and a written report.
Visit / Evaluation:01107: Office visit.
- Not paid with other listings.
- Not paid with other listings.
- Applies only on weekdays, excluding statutory holidays.
- Out-of-Office Hour Premiums are not applicable.
- Not paid with other listings
- Applies only on Saturday, Sunday, or statutory holidays
- Out-of-office Hour Premiums are not applicable
Call Outs & Continuing Care PremiumsA call out is a premium added when you are called from outside of the hospital to come and care for a patient. During weekdays the call must be placed prior to 8:00am or after 6:00pm. On weekends the call must be placed after 8:00am. REMINDER: If you’re called during regular weekday hours you’d bill an emergency visit instead, which covers both the visit and the surcharge.
Continuing CareIf you have logged a Call Out charge and then continue to see additional patients you would be entitled to bill continuing care surcharges for each 30 minutes after the initial 30 minutes you spent with the patient you were initially called to see. If you see multiple patients in a 30 minute block you would only log the continuing care on the last patient in that block but for the entire 30 minute period. You must also note CCFPP in the MSP note field to tell MSP that these patients were seen following your initial call out to the hospital.
Continuing Care RulesTiming begins after the first 30 minutes for consultations, visits or anesthetic evaluations. Payment is based on one half-hour of care or major portion thereof (at least 15 mins.). This means that your first continuing care surcharge is only eligible after 45 minutes of continuous care (30 mins. for the refractory period plus the major portion of 15 minutes). Timing for the continuing care premium is based on the total time spent providing continuous care, not the number of patients you see. For example, if you see 3 patients within 30 minutes then you would only add the continuing care premium on the last patient, but for the entire 30-minute duration. To apply these surcharges on Dr. Bill, log your consult or visit with the patient. On that claim toggle ‘Call Out & Continuing Care’. Don’t forget to enter the Call Time, Start Time & End Time for your encounter. Our app will automatically apply the correct Out of Office premiums to your claim. Reminder: Only toggle Call-Out on the first patient, to show that it was the first. For the following claims just toggle Cont.Care. If you need to claim a call out on its own or aren’t using Dr. Bill then use the following fee codes:
Call Out Fee codes:01200: Evening (call placed between 6:00pm and 11:00pm and service rendered between 1800 hours and 0800 hours) 01201: Night (call placed and service rendered between 11:00pm hours and 8:00am) 01202: Saturday, Sunday or Statutory Holiday (call placed between 8:00am and 11:00pm)
Continuing Care Surcharge Fee Codes (non-operative):Billed in addition to visits and consultation fees. 01205: Evening (service rendered between 6:00pm and 11:00pm) – per half hour or major part there of 01206: Night (service rendered between 11:00pm hours and 8:00am) – per half hour or major part thereof 01207: Saturday, Sunday or Statutory Holiday (Service rendered between 8:00am and 11:00pm) – per half hour or major part thereof
Anesthetic Procedural Fees:The anaesthetic intensity/complexity level will be listed in the schedule opposite the specific surgical, diagnostic and/or therapeutic procedure that you are providing to the patient. Anaesthetic intensity level/complexity time units are also indicated in the listing - these represent the different degrees of complexity and intensity for each procedure. Fees for your time are allocated in accordance to this intensity/complexity. Intensity and Complexity Index Intensity/Complexity Fee: For each 15 minute Level Code or part thereof. Level 2: 01172 Level 3: 0117 Level 4: 01174 Level 5: 01175 Level 6: 01176 Level 7: 01177 Level 8: 01178 Level 9: 01179 Level 10: 01180 Level 11: 01181 01088: P.A.R. (Post-Anesthetic Recovery)
- Critical Care: your critical care time spent with the patient begins when the anesthetic finishes (for example, a post-operative abdominal aortic aneurysm on a ventilator).
- Resuscitation: used for life-threatening emergencies in the P.A.R. (e.g.: respiratory arrest in the recovery room requiring intubation).
Anesthetic Procedural Fee Modifiers:These are fixed fees that are paid in addition to the basic anesthetic procedural fees - these give you additional compensation for performing anaesthesia in certain situations. They are not included in the anesthetic procedural fee for the application of 01080. 01059: Prone position 01065: Patients under 1 year of age
- Note: Not to be billed in addition to 01168.
- Note: Applicable only when airway score is 3 or 4.
- Restricted to certified specialists in anaesthesiology and payable only when fee items 01172, 01173, 01174, 01175, 01176, 01177, 01178, 01179, 01180, 01181, 01005, 01106, 01110, or 01111 are also payable.
- Applicable to all patients ≥ 19 years of age with a BMI ≥ 35 and to all patients < 19 years of age with a BMI ≥ 97th percentile adjusted for age and gender.
- You must provide the patient’s BMI in the claim note record and document it on the patient’s anesthetic record.
- All patients (except cardiac surgery patients) who have an incapacitating, systemic disease which is a constant threat to life, or who are not expected to survive for 24 hours, i.e. ASA 4 or 5.
- Cardiac surgery patients who have emergency surgery, i.e. ASA 4E or 5E.
- Cardiac or transplant surgery patients who require an IABP or mechanical assist device.
- All cases where the surgical time as noted on the OR record is 8 hours or more. This includes cardiac surgery.
Diagnostic and Therapeutic Anesthetic:These fees are for diagnostic and therapeutic procedures not associated with surgery. They are not eligible for out-of-office or continuing care service charges or procedural fee modifiers. 01124: Peripheral nerve block - single 01125: Peripheral nerve block – multiple 01135: Lumbar Epidural block 01140: single nerve Root or Facet Blocks ( Cervical ) 01141: multiple nerve Root or Facet Blocks ( Cervical ) 01142: single nerve Root or Facet Blocks (Thoracic) 01143: multiple nerve Root or Facet Blocks (Thoracic) 01144: single nerve Root or Facet Blocks (Lumbar) 01145: multiple nerve Root or Facet Blocks (Lumber)
- Note: Fee items 01140, 01141, 01142, 01143, 01144 and 01145 must be performed under medical imaging guidance (ultrasound, fluoroscopy or CT) with image capture.
Resuscitation by an Anesthesiologist:01088: Resuscitation by an anesthesiologist, requiring continuous bedside care - per 15 minutes or part thereof
- Includes endotracheal intubation, cricothyroidotomy, chest tube drainage, monitoring, and pacemaker insertion.
- Consultation not paid in addition.
- Applicable where the Apgar score is 5 or less, as noted on the delivery record.
- Includes endotracheal intubation and/or umbilical vessel catheterization.
- Consultation not paid in addition
- Applicable to removal and reinsertion of ET tube.
- Consultation not paid in addition
Obstetric Analgesia Fees:01102: Insertion of epidural catheter. To include initial injection and/or set-up of infusion for analgesia during labour
Supervision of Labour Epidural Analgesia01047: Medical Supervision of Labour Epidural Analgesia: Daytime (Monday to Friday, 0800-1800 hrs), per 5 minutes (or major portion thereof) 01048: Medical Supervision of Labour Epidural Analgesia: Evening (Monday to Friday, 1800-2300 hours), and Weekends (Saturday & Sunday, 0800-2300 hours) and Statutory Holidays (0800-2300 hours), per 5 minutes (or major portion thereof) 01049: Medical Supervision of Labour Epidural Analgesia: Night (Monday to Sunday, 2300-0800 hours), per 5 minutes (or major portion thereof)
- You are allowed to bill these fees concurrently with services provided to other patients, including concurrent payment of fee items 01047, 01048, 01049 for more than one patient.
- The fee items 01047, 01048, 01049 are payable to a maximum of 48 units per patient, per maternity.
- 4 hours duration of medical supervision (48 time units)
- Time of birth
- Time when payment begins for anesthetic care on the same patient related to c-section, complicated delivery, or surgical delivery.
Acute Pain Management:01013: Used for a consultation by a certified specialist in anesthesia for assessment of the patient for postoperative acute pain management. It can be used when the consultation is requested after admission and either prior to surgery or within 24 hours following the end of surgery. 01073: Hospital visit for supervision of epidural infusion to a maximum of 2 per day - per visit
- Note: Where more than 2 visits per day are necessary, an explanatory note in the claim note record is required.
- Where more than 2 visits per day are necessary, an explanatory note in the claim note record is required.
- 01012 is not payable on the same day as 01011.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
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