Hello everyone and Happy June!  We hope you all enjoyed your Memorial Day Weekend which signals the start of summer in most of our minds.  We also know that this means a busy “Wisdom Tooth Season” for oral surgery offices!  Are you ready?  Of course you are!

Last month at the JAWS meeting in TX we tried out a new format.  Rather than doing a typical formal presentation, we took questions from the group and had an open roundtable discussion.  The questions were submitted in advance so I had the opportunity to review them ahead of time.  Since anesthesia continues to be a hot topic for a lot of offices and there is still some confusion regarding how to bill anesthesia services to a medical carrier below is some of what I shared with the group during the meeting.  I think you will find it helpful!

The question and problem comes in when you are trying to get coverage for anesthesia when reporting a non-odontogenic related service (biopsy, fractures, etc.).   Some offices are still trying to report CPT 00170 (Anesthesia for intraoral procedures, including biopsy; not otherwise specified).  This code is intended to be used when billing for a separate provider and should not be used to bill for anesthesia by surgeon.  If you are working with a medical carrier that wants you to report anesthesia services, get it in writing.   Some offices were trying to report 00170 with the 47 modifier (anesthesia by surgeon).  Sounds like a great idea, however, that modifier cannot be reported with 00170 codes.  Your claim will kick out as a mismatched modifier (not all modifiers can be reported with all codes).   The correct way to bill using the 47 modifier is to report the surgical procedure first and then on an additional line report the same CPT code with the 47 modifier.  For example, if you are billing for removal of lesion of the vestibule with closure and anesthesia you would report 40812 on one line and on the second line report 40812 with the 47 modifier.   Some carriers will accept the 47 modifier, others do not.

Another option is to report using the moderate sedation codes 99152 and 99153.    By CMS guidelines in order to report 99152 there must be at least 10 minutes of intra-operative time.   In order to bill for 99153 the 8-minute rule applies.  At least 8 minutes of time in each additional 15-minute time frame.  For example, a total of 20 minutes of moderate sedation would be reported as 99152.   In order to bill for the additional code of 99153 at least 23 minutes of anesthesia would have had to be performed (i.e. 8 minutes into the second unit).  

Many carriers are requesting the actual minutes to be reported so they can audit the number of units reported.    There are two ways to report the total minutes of anesthesia; you can report it in box 19 of the claim form (remarks section, free text) or you can report it in the shaded area in box 24 right above the line where the procedure code is reported.  Report the ZZ claim modifier (to let the carrier know you are reporting a narrative) and put the total minutes.