CPT code 01965 is used for anesthesia services during incomplete or missed abortion procedures, ensuring accurate service documentation.
CPT code 01965 is used to describe anesthesia services provided during procedures related to incomplete or missed abortion. This code is specifically utilized by anesthesiologists or anesthesia providers to bill for their services when they administer anesthesia to a patient undergoing a surgical procedure to address an incomplete or missed abortion. The code ensures that the anesthesia component of the procedure is accurately documented and reimbursed by insurance providers.
For CPT code 01965, which pertains to anesthesia services, 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 related procedure is performed during the postoperative period of the initial procedure.
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 Certified Registered Nurse Anesthetist (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.
These modifiers help provide additional information about the circumstances under which the anesthesia service was provided, ensuring accurate billing and reimbursement. Proper documentation is essential to support the use of these modifiers.
The CPT code 01965 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 reimbursement for CPT code 01965 can vary based on geographical location and other factors, as determined by the respective Medicare Administrative Contractor (MAC) for the provider's region. MACs are responsible for processing Medicare claims and ensuring that services meet the necessary coverage criteria. Therefore, healthcare providers should consult their local MAC for detailed information on the reimbursement specifics for CPT code 01965.
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