CPT code 01480 is used for anesthesia services during lower leg bone surgery, ensuring accurate documentation and reimbursement for healthcare providers.
CPT code 01480 is used to describe anesthesia services provided for surgical procedures on the bones of the lower leg. This code is specifically applicable when anesthesia is administered to facilitate surgeries involving the tibia or fibula, which are the two primary bones in the lower leg. The use of this code ensures that the anesthesia services are accurately documented and billed, allowing for proper reimbursement from insurance providers. It is essential for healthcare providers to use the correct CPT code to reflect the specific type of anesthesia service rendered during the surgical procedure.
For CPT code 01480, which pertains to anesthesia for lower leg bone 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. Documentation must support the substantial additional work and the reason for it.
2. Modifier 23 - Unusual Anesthesia: This modifier is used 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 modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures/services 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 physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional 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 modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period.
9. Modifier AA - Anesthesia Services Performed Personally by Anesthesiologist: This modifier is used to indicate 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 modifier is used when an anesthesiologist provides medical direction for two to four concurrent anesthesia procedures.
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 modifier 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 modifier is used when an anesthesiologist provides medical direction for one CRNA.
14. Modifier QZ - CRNA Service: Without Medical Direction by a Physician: This modifier is used when a CRNA provides anesthesia services without the medical direction of a physician.
Each of these modifiers serves a specific purpose and should be used according to the circumstances of the anesthesia service provided. Proper documentation is essential to support the use of any modifier.
CPT code 01480 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) provides the framework for determining the reimbursement rates for services covered under Medicare Part B, including anesthesia services like those associated with CPT code 01480. The reimbursement amount can vary based on geographic location and other factors.
Medicare Administrative Contractors (MACs) play a crucial role in processing claims and ensuring compliance with Medicare policies. They are responsible for interpreting national policies and may have additional local coverage determinations that affect the reimbursement of CPT code 01480. Healthcare providers should consult their specific MAC for detailed information on coverage and reimbursement rates for this code in their region.
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