CPT code 00474 is used for anesthesia services during rib surgery, ensuring accurate documentation and reimbursement for healthcare providers.
CPT code 00474 is used to describe anesthesia services provided during surgical procedures involving the ribs. This code is specifically designated for the administration of anesthesia to patients undergoing rib surgery, ensuring that they remain comfortable and pain-free throughout the procedure. It is important for healthcare providers to accurately use this code to ensure proper billing and reimbursement for the anesthesia services rendered during such surgeries.
When dealing with CPT code 00474, which pertains to anesthesia for surgery of the rib, the following modifiers may be applicable. These modifiers are used to provide additional information about the service provided and can affect reimbursement:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide the service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 23 - Unusual Anesthesia: This is applicable when a procedure that usually requires either no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.
3. Modifier 47 - Anesthesia by Surgeon: This modifier is used when the surgeon administers regional or general anesthesia to the patient. It is not used for local anesthesia.
4. Modifier 59 - Distinct Procedural Service: This is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to identify procedures that are not normally reported together but are appropriate under the circumstances.
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 subsequent to the original procedure or service.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when a procedure or service is repeated by a different provider subsequent to the original procedure or service.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when a procedure performed during the postoperative period is unrelated to the original procedure.
9. Modifier AA - Anesthesia Services Performed Personally by Anesthesiologist: This indicates that the anesthesiologist personally performed the anesthesia service.
10. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: This is used when an anesthesiologist is directing multiple anesthesia procedures.
11. Modifier QS - Monitored Anesthesia Care Service: This indicates that the service provided was monitored anesthesia care.
12. Modifier QX - CRNA Service: With Medical Direction by a Physician: This is used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
13. Modifier QY - Medical Direction of One Certified Registered Nurse Anesthetist (CRNA) by an Anesthesiologist: This indicates that an anesthesiologist is directing one CRNA.
14. Modifier QZ - CRNA Service: Without Medical Direction by a Physician: This is used when a CRNA provides anesthesia services without the medical direction of a physician.
These modifiers help clarify the circumstances under which the anesthesia service was provided and ensure accurate billing and reimbursement. Proper documentation is essential when using these modifiers to support the claims submitted.
CPT code 00474, which is related to anesthesia for surgery of the rib, is subject to reimbursement by Medicare, but it is essential to verify its status on the Medicare Physician Fee Schedule (MPFS) for the most accurate and up-to-date information.
The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates.
Additionally, reimbursement can vary based on the specific Medicare Administrative Contractor (MAC) that processes claims in your region, as MACs have the authority to make local coverage determinations.
Therefore, healthcare providers should consult their regional MAC for any specific guidelines or variations in reimbursement policies related to CPT code 00474.
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