CPT code 01474 is used for anesthesia services during lower leg surgery, ensuring accurate documentation and reimbursement for healthcare providers.
CPT code 01474 is used to describe anesthesia services provided for surgical procedures on the lower leg, below the knee. This code is specifically utilized by anesthesiologists and other qualified healthcare professionals to document and bill for the administration of anesthesia during surgeries involving the lower leg, ensuring that the patient remains comfortable and pain-free throughout the procedure. The use of this code helps streamline the billing process and ensures accurate reimbursement for the anesthesia services rendered.
For CPT code 01474, which pertains to anesthesia for lower leg surgery, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is 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 took significantly longer 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.
3. Modifier 47 - Anesthesia by Surgeon: This modifier is applicable if the surgeon administers the anesthesia themselves, which is uncommon but possible in certain scenarios.
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 may be necessary if multiple procedures are performed and need to be billed separately.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same procedure is repeated by the same physician, which might occur if additional anesthesia is required during the same operative session.
6. Modifier 77 - Repeat Procedure by Another Physician: This is used when a procedure is repeated by a different physician, which might be relevant if there is a change in the anesthesia provider during the surgery.
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 if the patient needs to return to the operating room for a related procedure during the postoperative period, requiring additional anesthesia.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
9. Modifier AA - Anesthesia Services Performed Personally by Anesthesiologist: This modifier indicates that the anesthesia services were personally performed by an anesthesiologist.
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 simultaneously.
11. Modifier QS - Monitored Anesthesia Care Service: This modifier is used to indicate that monitored anesthesia care was provided.
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 CRNA by an Anesthesiologist: This indicates that an anesthesiologist is providing medical direction for a single 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 provide additional context and specificity to the billing of anesthesia services, ensuring accurate reimbursement and compliance with payer requirements.
The CPT code 01474 is reimbursed by Medicare, but its 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 and the corresponding payment rates.
However, the actual reimbursement for CPT code 01474 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for interpreting national Medicare policies and setting local coverage determinations, which can influence whether and how much a provider is reimbursed for this specific code.
Therefore, healthcare providers should consult their local MAC for detailed information on the reimbursement specifics for CPT code 01474.
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