|
24.3.3.3 Services Incidental to Surgery and/or Anesthesia
The CSHCN Services Program considers the procedures listed below incidental to surgery or anesthesia. If the surgeon, assistant surgeon, anesthesiologist, or facility bills the following procedure codes in conjunction with surgery or anesthesia, they are denied as part of another procedure billed on the same day.
The following table includes procedure codes that are not considered incidental to surgery or anesthesia procedures and may be reimbursed separately in the inpatient and outpatient setting:
Authorization is not required for these services when they are incidental to surgery, assistant surgery, or anesthesia. Multiple surgical procedures billed on the same day by the same provider are subject to the multiple surgery guidelines. The surgical procedure codes that are not considered incidental to surgery or anesthesia require authorization when performed as outpatient hospital day surgery in an ASC or hospital ambulatory surgical center (HASC).
When procedure codes 2-31500, 4/I/T-93312, 4-93313, 4/I/T-93314, 4/I/T-93315, 4-93316, and 4/I/T-93317, or 1-99291 and 1-99292 are performed due to a separate incident not related to the original surgery after the post-operative recovery period, they may be considered for reimbursement on appeal with appropriate documentation of medical necessity.
Procedure codes 4/I/T-93312, 4-93313, 4/I/T-93314, 4/I/T-93315, 4-93316, and 4/I/T-93317 may be considered for the exception noted above with documentation of a formal report.
If the need arises for a monitoring line such as a central venous catheter in the post-operative period (e.g., in the recovery room), this may be considered for payment as an additional service on appeal with appropriate documentation. Payment for monitoring lines when billed as the sole procedure performed may be considered for reimbursement.
Providers must code the procedures in Block 24D of the CMS-1500 claim form with a valid CPT anesthesia code.
If procedure code 1-01996 is used, it must be reported as a medical service rather than an anesthesia service.
|
