TMPPM 2011 > Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook > Physician > Services/Benefits, Limitations, and Prior Authorization > Surgery Billing Guidelines > Services Incidental to Surgery and/or Anesthesia

   
 

8.2.70.11 Services Incidental to Surgery and/or Anesthesia

Surgical and anesthesia services are benefits of Texas Medicaid when they are medically necessary.

Certain services that are performed in conjunction with surgical or anesthesia procedures are considered incidental to the surgery or anesthesia and are denied as included in the surgical/anesthesia fee. The following table (not an all-inclusive list) includes services that are incidental to surgery or anesthesia:

Procedure Codes

31500

36010

36420

36425

36430

36440

76998

82800

82803

82805

82810

82820

93005

93017

93041

93312

93313

93314

93315

93316

93317

93561

93562

94002

94003

94010

94060

94680

94681

94690

94760

94761

94770

96360

96361

96365

96366

96367

96368

96521

96522

96523

99143

99144

99145

99231

99232

99233

99291

99292

L8603

L8606

When performed for diagnostic purposes due to a separate incident that is not related to the original surgery after the postoperative recovery period, procedure codes 93312, 93313, 93314, 93315, 93316, and 93317 (transesophageal echocardiography) may be considered for reimbursement on appeal with documentation of a formal report.

Critical care procedure codes 99291 and 99292 performed due to a separate incident not related to the original surgery after the postoperative recovery period may be considered for reimbursement on appeal with appropriate documentation.

Procedure codes 33967, 33970, 36013, and 36014 (not an all-inclusive list) are services that are incidental to the anesthesia fee.

Placement (insertion) of a central venous catheter is denied as part of another procedure when procedure 33970 is billed on the same day. Separate payment for the insertion of monitoring lines is not available. Reimbursement for the insertion of monitoring lines is included in the anesthesia fee when the time units are calculated.

Procedure code 99143 will be denied if billed on the same date of service by the same provider as procedure code 99144.

Should the need arise for the insertion of a monitoring line due to a separate incident not related to the original surgery after the postoperative recovery period, reimbursement may be considered on appeal with appropriate documentation. Reimbursement for monitoring lines submitted as the sole procedure performed is allowed.

The following procedure codes will be denied when billed on the same date of service by the same provider as procedure codes 99143 or 99144:

Procedure Codes

36000

36400

36405

36406

36410

36420

36425

93000

93040

93041

93042

94760

94761

96360

96365

96372

96373

96374

96375

96376

99201

99202

99203

99204

99205

99211

99212

99213

99214

99215

99217

99218

99219

99220

99221

99222

99223

99231

99232

99233

99234

99235

99236

99238

99239

99241

99242

99243

99244

99245

99251

99252

99253

99254

99255

99281

99282

99283

99284

99285

99291

99292

99304

99305

99306

99307

99308

99309

99310

99315

99316

99318

99324

99325

99326

99327

99328

99334

99335

99336

99337

99341

99342

99343

99344

99345

99347

99348

99349

99350

99354

99355

99356

99357

99468

99469

99471

99472

99475

99476

99477

99478

99479

99480

The following table includes procedure codes that are not incidental to surgery or anesthesia procedures and may be considered for reimbursement separately in addition to the surgery or anesthesia service in the inpatient or outpatient setting:

Procedure Codes

36555

36556

36557

36558

36560

36561

36563

36565

36566

36568

36569

36620

36625

93503

Should the need arise for the insertion of a monitoring line due to a separate incident not related to the original surgery after the postoperative recovery period, reimbursement may be considered on appeal with appropriate documentation. Reimbursement for monitoring lines submitted as the sole procedure performed is allowed.


Texas Medicaid & Healthcare Partnership
CPT only copyright 2010 American Medical Association. All rights reserved.
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