CHAPTER IIANESTHESIA SERVICESCPT CODES 00000-01999NATIONAL CORRECT CODING INITIATIVE POLICY MANUALFOR MEDICAID SERVICESRevised January 1, 2021Current Procedural Terminology (CPT) codes, descriptions andother data only are copyright 2020 American Medical Association.All rights reserved.CPT is a registered trademark of the American MedicalAssociation.Applicable FARS\DFARS Restrictions Apply to Government Use.Fee schedules, relative value units, conversion factors,prospective payment systems and/or related components are notassigned by the AMA, are not part of CPT, and the AMA is notrecommending their use. The AMA does not directly or indirectlypractice medicine or dispense medical services. The AMA assumesno liability for the data contained or not contained herein.Revision Date (Medicaid): 1/1/2021
Table of ContentsChapter II . II-4Anesthesia Services CPT Codes 00000–01999 . II-4A.Introduction .II-4B.Standard Anesthesia Coding .II-5C.Radiologic Anesthesia Coding .II-15D.Monitored Anesthesia Care .II-16E.General Policy Statements .II-16Revision Date (Medicaid): 1/1/2021II-3
Chapter IIAnesthesia ServicesCPT Codes 00000–01999A.IntroductionThe principles of correct coding discussed in Chapter I apply tothe Current Procedural Terminology (CPT) codes in the range00000-01999. Several general guidelines are repeated in thisChapter. However, those general guidelines from Chapter I notdiscussed in this chapter are nonetheless applicable.Physicians shall report the Healthcare Common Procedure CodingSystem/Current Procedural Terminology (HCPCS/CPT) code thatdescribes the procedure performed to the greatest specificitypossible. A HCPCS/CPT code shall be reported only if allservices described by the code are performed. A physician shallnot report multiple HCPCS/CPT codes if a single HCPCS/CPT codeexists that describes the services performed. This type ofunbundling is incorrect coding.The HCPCS/CPT codes include all services usually performed aspart of the procedure as a standard of medical/surgicalpractice. A physician shall not separately report these servicessimply because HCPCS/CPT codes exist for them.Specific issues unique to this section of CPT are clarified inthis chapter.Anesthesia care is provided by an anesthesia practitioner whomay be a physician, a certified registered nurse anesthetist(CRNA) with or without medical direction, or an anesthesiaassistant (AA) with medical direction. The anesthesia carepackage consists of preoperative evaluation, standardpreparation and monitoring services, administration ofanesthesia, and post-anesthesia recovery care.Preoperative evaluation includes a sufficient history andphysical examination so that the risk of adverse reactions canbe minimized, alternative approaches to anesthesia planned, andall questions regarding the anesthesia procedure by the patientor family answered. Types of anesthesia include local,regional, epidural, general, moderate conscious sedation, ormonitored anesthesia care. The anesthesia practitioner assumesresponsibility for anesthesia and related care rendered in thepost-anesthesia recovery period until the patient is released tothe surgeon or another physician.Revision Date (Medicaid): 1/1/2021II-4
Anesthesiologists may personally perform anesthesia services ormay supervise anesthesia services performed by a CRNA or AA.CRNAs may perform anesthesia services independently or under thesupervision of an anesthesiologist or operating practitioner.An AA always performs anesthesia services under the direction ofan anesthesiologist.B.Standard Anesthesia CodingThe following policies reflect the National Correct CodingInitiative (NCCI) program correct coding guidelines foranesthesia services.1.The CPT codes 00100-01860 specify "Anesthesia for"followed by a description of a surgical intervention. The CPTcodes 01916-01936 describe anesthesia for radiologicalprocedures. Several CPT codes (01951-01999, excluding 01996)describe anesthesia services for burn excision/debridement,obstetrical, and other procedures. The CPT codes 99151-99157describe moderate (conscious) sedation services.Anesthesia services include, but are not limited to,preoperative evaluation of the patient, administration ofanesthetic, other medications, blood, and fluids, monitoring ofphysiological parameters, and other supportive services.Anesthesia codes describe a general anatomic area or servicewhich usually relates to a number of surgical procedures, oftenfrom multiple sections of the “CPT Manual.” Only one anesthesiacode is reported unless the anesthesia code is an Add-on Code(AOC). In this case, both the code for the primary anesthesiaservice and the anesthesia AOC code are reported according to"CPT Manual" instructions.2.A unique characteristic of anesthesia coding is thereporting of time units. Payment for anesthesia servicesincreases with time. In addition to reporting a base unit valuefor an anesthesia service, the anesthesia practitioner reportsanesthesia time. Anesthesia time is defined as the periodduring which an anesthesia practitioner is present with thepatient. It starts when the anesthesia practitioner begins toprepare the patient for anesthesia services in the operatingroom or an equivalent area and ends when the anesthesiapractitioner is no longer furnishing anesthesia services to thepatient (i.e., when the patient may be placed safely underpostoperative care). Anesthesia time is a continuous timeRevision Date (Medicaid): 1/1/2021II-5
period from the start of anesthesia to the end of an anesthesiaservice. In counting anesthesia time, the anesthesiapractitioner can add blocks of time around an interruption inanesthesia time as long as the anesthesia practitioner isfurnishing continuous anesthesia care within the time periodsaround the interruption.Example: A patient who undergoes a cataract extraction mayrequire monitored anesthesia care (see below). This may requireadministration of a sedative in conjunction with aperi/retrobulbar injection for regional block anesthesia.Subsequently, an interval of 30 minutes or more may transpireduring which time the patient does not require monitoring by ananesthesia practitioner. After this period, monitoring willcommence again for the cataract extraction and ultimately thepatient will be released to the surgeon’s care or to recovery.The time that may be reported would include the time for themonitoring during the block and during the procedure. Theinterval time and the recovery time are not included in theanesthesia time calculation. Also, if unusual services notbundled into the anesthesia service are required, the time spentdelivering these services before anesthesia time begins or afterit ends may not be included as reportable anesthesia time.However, if it is medically necessary for the anesthesiapractitioner to continuously monitor the patient during theinterval time and not perform any other service, the intervaltime may be included in the anesthesia time.3.It is standard medical practice for an anesthesiapractitioner to perform a patient examination and evaluationprior to surgery. This is considered part of the anesthesiaservice and is included in the base unit value of the anesthesiacode. The evaluation and examination are not reported in theanesthesia time. If surgery is canceled, subsequent to thepreoperative evaluation, payment may be allowed to theanesthesiologist for an Evaluation & Management (E&M) serviceand the appropriate E&M code may be reported. (A non-medicallydirected CRNA may also report an E&M code under thesecircumstances if permitted by state law.)Similarly, routine postoperative evaluation is included in thebase unit for the anesthesia service. If this evaluation occursafter the anesthesia practitioner has safely placed the patientunder postoperative care, neither additional anesthesia timeunits nor E&M codes shall be reported for this evaluation.Postoperative E&M services related to the surgery are notRevision Date (Medicaid): 1/1/2021II-6
separately reportable by the anesthesia practitioner except whenan anesthesiologist provides significant, separatelyidentifiable ongoing critical care services.Anesthesia practitioners other than anesthesiologists and CRNAscannot report E&M codes except as described above when asurgical case is canceled.If permitted by state law anesthesia practitioners mayseparately report significant, separately identifiablepostoperative management services after the anesthesia servicetime ends. These services include, but are not limited to,postoperative pain management and ventilator managementunrelated to the anesthesia procedure.Management of epidural or subarachnoid drug administration (CPTcode 01996) is separately payable on dates of service subsequentto surgery but not on the date of surgery. If the only serviceprovided is management of epidural/subarachnoid drugadministration, then an E&M service shall not be reported inaddition to CPT code 01996. Payment for management ofepidural/subarachnoid drug administration is limited to one unitof service per postoperative day regardless of the number ofvisits necessary to manage the catheter per postoperative day(CPT definition). While an anesthesiologist or non-medicallydirected CRNA may be able to report this service, only onepayment will be made per day.Postoperative pain management services are generally provided bythe surgeon who is reimbursed under a global payment policyrelated to the procedure and shall not be reported by theanesthesia practitioner unless separate, medically necessaryservices are required that cannot be rendered by the surgeon.The surgeon is responsible for documenting in the medical recordthe reason care is being referred to the anesthesiapractitioner.In certain circumstances critical care services are provided bythe anesthesiologist. CRNAs may be paid for E&M services in thecritical care area if state policy, law and/or regulation permitthem to provide such services. In the case of anesthesiologists,the routine immediate postoperative care is not separatelyreported except as described above. Certain procedural servicessuch as insertion of a Swan-Ganz catheter, insertion of acentral venous pressure line, emergency intubation (outside ofthe operating suite), etc., are separately payable toanesthesiologists as well as non-medically directed CRNAs ifRevision Date (Medicaid): 1/1/2021II-7
these procedures are furnished within the parameters of statelicensing laws.4.Under certain circumstances, an anesthesiapractitioner may separately report an epidural or peripheralnerve block injection (bolus, intermittent bolus, or continuousinfusion) for postoperative pain management when the surgeonrequests assistance with postoperative pain management. Anepidural injection (CPT code 623XX) for postoperative painmanagement may be reported separately with an anesthesia 0XXXXcode only if the mode of intraoperative anesthesia is generalanesthesia and the adequacy of the intraoperative anesthesia isnot dependent on the epidural injection. A peripheral nerveblock injection (CPT code 64XXX)for postoperative painmanagement may be reported separately with an anesthesia 0XXXXcode only if the mode of intraoperative anesthesia is generalanesthesia, subarachnoid injection, or epidural injection, andthe adequacy of the intraoperative anesthesia is not dependenton the peripheral nerve block injection. An epidural orperipheral nerve block injection (code numbers as identifiedabove) administered preoperatively or intraoperatively is notseparately reportable for postoperative pain management if themode of anesthesia for the procedure is monitored anesthesiacare, moderate conscious sedation, regional anesthesia byperipheral nerve block, or other type of anesthesia notidentified above. If an epidural or peripheral nerve blockinjection (code numbers as identified above)for postoperativepain management is reported separately on the same date ofservice as an anesthesia 0XXXX code, modifier 59 or XU may beappended to the epidural or peripheral nerve block injectioncode (code numbers as identified above) to indicate that it wasadministered for postoperative pain management. An epidural orperipheral nerve block injection (code numbers as identifiedabove)for postoperative pain management in patients receivinggeneral anesthesia, spinal (subarachnoid injection) anesthesia,or regional anesthesia by epidural injection as described abovemay be administered preoperatively, intraoperatively, orpostoperatively.5.If an epidural or subarachnoid injection (bolus,intermittent bolus, or continuous) is used for intraoperativeanesthesia and postoperative pain management, CPT code 01996(daily hospital management of epidural or subarachnoidcontinuous drug administration) is not separately reportable onthe day of insertion of the epidural or subarachnoid catheter.CPT code 01996 may only be reported for management for dayssubsequent to the date of insertion of the epidural orRevision Date (Medicaid): 1/1/2021II-8
subarachnoid catheter.6.Anesthesia HCPCS/CPT codes include all servicesintegral to the anesthesia procedure such as preparation,monitoring, intra-operative care, and post-operative care untilthe patient is released by the anesthesia practitioner to thecare of another physician. Examples of integral servicesinclude, but are not limited to, the following: Transporting, positioning, prepping, draping of the patientfor satisfactory anesthesia induction/surgical procedures. Placement of external devices including, but not limitedto, those for cardiac monitoring, oximetry, capnography,temperature monitoring, EEG, CNS evoked responses (e.g.,BSER), and Doppler flow. Placement of peripheral intravenous lines for fluid andmedication administration. Placement of airway (e.