CPT code 00904 is used for anesthesia services related to perineal surgery, helping standardize procedures for efficient healthcare management.
CPT code 00904 is used to describe anesthesia services provided for perineal surgery. This code is specifically designated for procedures involving the perineal region, which is the area between the anus and the genitals. Anesthesia services under this code ensure that the patient is adequately sedated and pain-free during the surgical procedure. This code is crucial for billing and documentation purposes, allowing healthcare providers to accurately report the anesthesia services rendered during perineal surgeries.
For CPT code 00904, which pertains to anesthesia for perineal surgery, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to provide the service is substantially greater than typically required. This could apply if the anesthesia procedure was more complex or time-consuming than usual.
2. Modifier 23 (Unusual Anesthesia): Applied when a procedure that usually requires no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.
3. Modifier 47 (Anesthesia by Surgeon): Used when the surgeon administers regional or general anesthesia to the patient. This is not commonly used with anesthesia codes but may be relevant in specific scenarios.
4. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This might be used if multiple procedures are performed that are not typically reported together.
5. Modifier 76 (Repeat Procedure by Same Physician): Used when the same procedure is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
6. Modifier 77 (Repeat Procedure by Another Physician): Similar to Modifier 76, but used when the repeat procedure is performed by a different physician or qualified healthcare professional.
7. Modifier 78 (Unplanned Return to the Operating/Procedure Room): Used when a related procedure during the postoperative period requires a return to the operating room.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician): Indicates that the procedure performed during the postoperative period was unrelated to the original procedure.
9. Modifier AA (Anesthesia Services Performed Personally by Anesthesiologist): Used to indicate that the anesthesiologist personally performed the anesthesia service.
10. Modifier QK (Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures): Used when an anesthesiologist is medically directing two to four concurrent anesthesia procedures.
11. Modifier QS (Monitored Anesthesia Care Service): Indicates that monitored anesthesia care was provided.
12. Modifier QX (CRNA Service with Medical Direction by a Physician): 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 CRNA by an Anesthesiologist): Indicates that an anesthesiologist is medically directing one CRNA.
14. Modifier QZ (CRNA Service without Medical Direction by a Physician): Used when a CRNA provides anesthesia services without the medical direction of a physician.
These modifiers help provide additional information about the circumstances under which the anesthesia service was provided, ensuring accurate billing and reimbursement. It's important to select the appropriate modifier based on the specific details of the procedure and the role of the healthcare professionals involved.
CPT code 00904 is subject to reimbursement by Medicare, but its eligibility for payment depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a comprehensive list of services and procedures that Medicare covers, along with the associated payment rates. However, the final determination of reimbursement for CPT code 00904 will be influenced by the local coverage determinations (LCDs) and policies established by the MAC responsible for your area.
It is essential for healthcare providers to verify the coverage and reimbursement specifics with their respective MAC to ensure compliance and accurate billing practices.
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