HealthNow UMD
Article -- Coding Guidelines

Contractor Name
HealthNow

Contractor Number
00801

Contractor Type
Carrier

Article Database ID Number
A34338

Contractor Determination Number
AN003E02 End dated

Article Type
Article

Article Title
Anesthesia for Anorectal Procedures -1 End dated

Is the AMA CPT / ADA CDT Copyright Statement Required?
Yes

CPT codes, descriptions and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. CDT-4 codes and descriptions are (C) 2002, 2004 American Dental Association. All rights reserved.

Primary Geographic Jurisdiction
Upstate New York

Original Article Effective Date
06/15/2005

Article Revision Effective Date
03/01/2007

Article Ending Effective Date
03/28/2008

Coding Guidelines

   1.  The guidelines of the Correct Coding Initiative (CCI) supersede all
       coding instructions in this LCD.

   2.  The diagnosis code(s) must best describe the patient's condition for
       which the service was performed.

   3.  Use CPT code 00902 for anesthesia care occurring during anorectal
       surgical procedures.

   4.  Use CPT code 00810 for anesthesia care occurring during lower
       intestinal endoscopy procedures not associated with anorectal surgery.
       Such claims should follow guidelines as explained in the Anesthesia
       for Gastrointestinal Endoscopy policy, # AN001E04.

   5.  Payable places of service for anesthesia for anorectal procedures are:
       office (11), inpatient hospital (21), outpatient hospital (22),
       emergency room - hospital (23), ambulatory surgical center (24),
       independent clinic (49) and state or local public health clinic (71).

   6.  Use the following modifiers where appropriate:

       Modifiers used by physicians:

       -    AA Anesthesia services performed personally by an
            anesthesiologist

       -    AD Medical supervision by a physician; more than four concurrent
            anesthesia procedures

       -    QK Medical direction of two, three or four concurrent anesthesia
            procedures involving qualified individuals

       -    QY Medical direction of one certified registered nurse
            anesthetist (CRNA) by an anesthesiologist

       -    QS Monitored anesthesia care services*

       Modifiers used by CRNA

       -    QS Monitored anesthesia care services

       -    QX CRNA/AA service; with medical direction by a physician*

       -    QZ CRNA/AA service; without medical direction by a physician

       * Use in conjunction with one of the other modifiers listed above.

CPT/HCPCS Codes

    00902          Anesthesia for anorectal procedure

Other Comments

   -   For services that exceed the accepted standard of medical practice and
       may be deemed not medically necessary, the provider/supplier should
       provide the patient with an acceptable advance notice of Medicare's
       possible denial of payment.  An advance beneficiary notice (ABN)
       should be signed when a provider/supplier does not want to accept
       financial responsibility for the service.

   -   This policy was developed in response to analysis of claims history,
       which indicated that this service was inappropriately being used to
       bill anesthesia services for lower gastrointestinal endoscopy rather
       than anorectal surgery.

Revision 1: Added guideline #2, updated Copyright statement and added place of service 49 as payable.

This Article was converted from an LMRP on 06/14/2005

Does this Article contain a "Least Costly Alternative" provision?
No