We are seeking clarity on HIPAA requirements related to billing anesthesia services. Per the HC codeset for professional procedure codes, reported in SV101-2, can anesthesia services be billed by sending a surgical procedure code, and an anesthesia modifier in SV101-3? Or must anesthesia services be billed only with anesthesia procedure codes, 00100-001999? Is this detail specified in the codeset? Bottom-line, are both types of billing acceptable? Is it different for 4010 versus 5010?
The SV101-2 is the procedure code for the service being reported on a particular service line and the SV101–3 is a procedure modifier for the procedure identified in the SV101-2. The note in the SV101–3 indicates that the procedure modifier “identifies special circumstances related to the performance of the service”.
In 005010, an HI Segment “Anesthesia Related Procedure” was added to allow reporting of the surgical procedure code related to the anesthesia services being billed when the conditions of the situational rule are met.