CPT code 00104 is used to identify anesthesia services provided during electroshock therapy, ensuring standardized communication among healthcare providers.
CPT code 00104 is used to describe the anesthesia services provided during electroconvulsive therapy (ECT), commonly known as electroshock therapy. This code is specifically designated for the administration of anesthesia to patients undergoing ECT, which is a psychiatric treatment where seizures are electrically induced in patients to provide relief from certain mental health conditions. The use of this code ensures that the anesthesia component of the procedure is accurately documented and billed, reflecting the specialized care required during such treatments.
For CPT code 00104, which pertains to anesthesia for electroconvulsive therapy, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required. It may be applicable if the anesthesia services for electroconvulsive therapy are more complex or time-consuming than usual.
2. Modifier 23 - Unusual Anesthesia: This modifier is used when a procedure that usually requires no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances. It could be relevant if the patient's condition necessitates general anesthesia for electroconvulsive therapy.
3. Modifier 47 - Anesthesia by Surgeon: This modifier is used when the surgeon administers regional or general anesthesia to the patient. It is rarely used in this context but could apply if the surgeon, rather than an anesthesiologist, provides the anesthesia.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if multiple distinct anesthesia services are provided.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by the same provider. It could be applicable if multiple sessions of electroconvulsive therapy are performed on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure is repeated by a different provider. It may be relevant if another provider administers anesthesia for a subsequent session on the same day.
7. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided. It may be applicable if multiple modifiers are needed to accurately represent the anesthesia service for electroconvulsive therapy.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the anesthesia services rendered.
CPT code 00104 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the actual reimbursement for CPT code 00104 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting payment policies within their jurisdiction, which means they may have additional requirements or documentation needed for reimbursement. Healthcare providers should consult their specific MAC for detailed information on coverage and reimbursement for CPT code 00104.
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