C.M.R. 90, 351, ch. 5, § 351-5-2, subsec. 351-5-2-03

Current through 2025-02, January 8, 2025

Subsection 351-5-2-03 - ANESTHESIA GUIDELINES

1. Definition of the Unit Components

A.Base Unit: RVU of the five digit anesthesia procedure code (00100-01999) listed in Appendix II plus the unit value of the physical status modifier plus the unit values for any qualifying circumstances.

Physical Status Modifiers. Physical Status modifiers are represented by the initial letter 'P' followed by a single digit from 1 to 6 as defined in the following list:

UNIT VALUE

P1: A normal healthy patient 0

P2: A patient with mild systemic disease 0

P3: A patient with severe systemic disease 1

P4: A patient with severe systemic disease that is a constant threat to life 2

P5: A moribund patient who is not expected to survive without the operation 3

P6: A declared brain-dead patient whose organs are being Removed for donor purposes 0

Qualifying Circumstances. More than one qualifying circumstance may be selected. Many anesthesia services are provided under particularly difficult circumstances, depending on factors such as the extraordinary condition of patient, notable operative conditions, and/or unusual risk factors. This section includes a list of important qualifying circumstances that significantly affect the character of the anesthesia service provided. These procedures would not be reported alone, but would be reported as additional procedure numbers qualifying as an anesthesia procedure or service.

UNIT VALUE

99100: Anesthesia for patient of extreme age, under one year and over seventy 1

99116: Anesthesia complicated by utilization of total body hypothermia 5

99135: Anesthesia complicated by utilization of controlled hypotension

5 99140: Anesthesia complicated by emergency conditions (an emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part) 2

B.Time Unit: Health care providers must bill the number of minutes of anesthesia time. One time unit is allowed for each 15 minute time interval, or significant fraction thereof (7.5 minutes or more) of anesthesia time. If anesthesia time extends beyond three hours, one time unit for each 10 minute time interval, or significant fraction thereof (5 minutes or more) is allowed after the first three hours. Documentation of actual anesthesia time is required, such as a copy of the anesthesia record.

2.Calculation Examples

A. In a procedure with a RVU of 3 (no modifiers) requiring one hour of anesthesia time, the total units are determined as follows:

Base Unit 3.0 units

Time Unit + 4.0 units

Total Units = 7.0 units

B. In a procedure with a RVU of 10, modifying units of 1 and qualifying circumstances of 2, requiring four hours and thirty minutes of anesthesia time, the total units are determined as follows:

Base Unit 13.0 units

Time Unit (First three hours) + 12.0 units

Time Unit (Subsequent 90 minutes) + 9.0 units

Total Units = 34.0 units

C. In both cases, the maximum allowable payment is determined by multiplying the total units by the conversion factor.

Total Units X Conversion Factor = Maximum Allowable Payment

CONVERSION FACTOR = $50.00

C.M.R. 90, 351, ch. 5, § 351-5-2, subsec. 351-5-2-03