I had an off-line conversation with someone at CMS regarding this issue and found out the following:
>From a purely HIPAA-compliance perspective, surgical CPT codes or anesthesia CPT codes can be used to report anesthesia services. Now, from a CPT coding perspective, using surgical codes to report anesthesia services is not an appropriate use of CPT codes. I was not aware that HIPAA adopted the CPT codes themselves, but not the CPT usage guidelines (unlike ICD9 where HIPAA adopted both the codes and the guidelines for use). Therefore, depending on your organization's unique reimbursement structure, you may use either type of CPT code to report anesthesia services - from a HIPAA-compliance perspective. Hope this helps. Paul ----- Original Message ----- From: Linda McCardel <[EMAIL PROTECTED]> Date: Monday, March 10, 2003 10:35 am Subject: RE: RE: Anesthesia v. Surgical Codes > Paul - You are correct that the rule says certain sets of codes > must be used > - CPT is one of those sets, and CPT identifies that the codes in > the range > of 0100-01999 must be used to report anesthesia services. The AMA > as the > owner of the codeset requires that anesthesia services be coded in > thismanner. Also, there are other guidelines within the CPT code > set that must > be followed as well - use of the modifiers is one. A payer can > elect not to > use a specific modifier, however if it is used, it must follow the > codeguideline use that the AMA specifies. The surgical procedure > codes are used > to report surgical services, not anesthesia services even though many > payers, (including the state Medicaid program I worked for) used > to do that. > During my involvement with the NMEH (National Medicaid EDI HIPAA) > workgroup,CMS verified that states who coded anesthesia services > using the surgical > codes must change their process and use the anesthesia codes once > HIPAA was > implemented. I hope this helps. > > -----Original Message----- > From: Paul Costello [mailto:[EMAIL PROTECTED] > Sent: Monday, March 10, 2003 1:23 PM > To: Linda McCardel; [EMAIL PROTECTED] > Subject: Re: RE: Anesthesia v. Surgical Codes > > > Linda, > > I respectfully disagree with you. If you look at the "body" of > the > transaction and code set rule that addressess the medical data > code > sets, the rule states that certain "sets" of codes (ICD-9, CPT, > HCPCS) > must be used for certain types of procedures, etc. The rule never > says > that Anesthesia CPT codes are required when coding for anesthesia > services - the rule says the CPT/HCPCS codes must be used. > > Paul > > ----- Original Message ----- > From: Linda McCardel <[EMAIL PROTECTED]> > Date: Monday, March 10, 2003 7:43 am > Subject: RE: Anesthesia v. Surgical Codes > > > Paul - Only the Anesthesia CPT codes are acceptable effective 10- > > 16-03. - > > using the CPT surgical codes is not an acceptable use of the > code > > structurebeginning 10-16-03 - that is what the Final Rule is > > saying. > > > > -----Original Message----- > > From: Paul Costello [mailto:[EMAIL PROTECTED] > > Sent: Friday, March 07, 2003 3:00 PM > > To: WEDI SNIP Transactions Workgroup List > > Subject: Anesthesia v. Surgical Codes > > > > > > Group, > > > > I know this topic has been addressed in the past, but I wanted > to ask > > again... > > > > When reporting anesthesia services, which codes (anesthesia CPT > or > > surgicalCPT or either) are required? > > > > A paragraph from the Standards for Electronic Transactions final > > rule (page > > 50361 of the August 17, 2000 Federal Register) states: > > > > "... there is significant variation in the reporting of > anesthesia > > services,with some health plans using the anesthesia section of > > CPT, and other > > requiring the anesthesiologist or nurse anesthetist to report > the > > code for > > the surgical procedure itself. When the HIPAA code sets become > > effective,health plans following the later convention will have > to > > begin accepting > > codes from the anesthesia section [of CPT]." > > > > I read this to mean that both types of codes will be allowed, > not just > > anesthesia CPT codes. > > > > I have seen other documentation that implies that only > anesthesia > > CPT codes > > will be allowed. > > > > Thoughts? > > > > Thanks, > > Paul > > > > > > > > --- > > The WEDI SNIP listserv to which you are subscribed is not > > moderated. The > > discussions on this listserv therefore represent the views of > the > > individualparticipants, and do not necessarily represent the > views > > of the WEDI Board > > of Directors nor WEDI SNIP. If you wish to receive an official > > opinion, post > > your question to the WEDI SNIP Issues Database at > > http://snip.wedi.org/tracking/. These listservs should not be > > used for > > commercial marketing purposes or discussion of specific vendor > > products and > > services. They also are not intended to be used as a forum for > > personaldisagreements or unprofessional communication at any time. > > > > You are currently subscribed to wedi-transactions as: > > [EMAIL PROTECTED] unsubscribe from this list, go to the > > Subscribe/Unsubscribe form at > > http://subscribe.wedi.org or send a blank email to > > [EMAIL PROTECTED] > > If you need to unsubscribe but your current email address is not > > the same as > > the address subscribed to the list, please use the > > Subscribe/Unsubscribeform at http://subscribe.wedi.org > > > > > > --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. 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