CPT CODES

CPT Code 01486

CPT code 01486 is used to identify anesthesia services provided during an ankle replacement procedure.

Table of Contents
What is CPT Code 01486
Does CPT 01486 Need a Modifier?
CPT Code 01486 Medicare Reimbursement
Are You Being Underpaid for 01486 CPT Code?
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What is CPT Code 01486

CPT code 01486 is used to describe the anesthesia services provided during an ankle replacement surgery. This code is specifically designated for the administration of anesthesia to a patient undergoing a surgical procedure to replace the ankle joint, which may be necessary due to conditions such as severe arthritis or injury. The code helps in accurately billing and documenting the anesthesia component of the procedure, ensuring that healthcare providers are reimbursed appropriately for their services.

Does CPT 01486 Need a Modifier?

For CPT code 01486, which pertains to anesthesia services for ankle replacement, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:

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 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 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 is used when a patient returns 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 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 is used when an anesthesiologist is directing multiple anesthesia procedures concurrently.

11. 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.

12. Modifier QY - Medical Direction of One Certified Registered Nurse Anesthetist (CRNA) by an Anesthesiologist: This is used when an anesthesiologist provides medical direction for one CRNA.

13. 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 information about the circumstances under which the anesthesia service was provided, ensuring accurate billing and reimbursement. It is important to use the appropriate modifier to reflect the specific situation accurately.

CPT Code 01486 Medicare Reimbursement

CPT code 01486, which is associated with anesthesia services, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines whether a specific CPT code is reimbursable and at what rate. The MPFS outlines the payment rates for services covered under Medicare Part B, including anesthesia services.

However, the reimbursement for CPT code 01486 can also vary based on the local policies set by the Medicare Administrative Contractor (MAC) responsible for your geographic region. MACs have the authority to make determinations on coverage and payment for services, which can include additional requirements or documentation for reimbursement.

Therefore, to confirm if CPT code 01486 is reimbursed by Medicare, healthcare providers should consult the MPFS for the specific year in question and also review any local coverage determinations (LCDs) or policies issued by their MAC. This dual approach ensures that providers are fully informed about the reimbursement status and any specific conditions that may apply.

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