Anthem Central Region Clinical Claims Edit
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1 Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Different Services with Anesthesia Services Edit #785 Effective Date: 9/20/ /31/2099 Status: Current Last Review Date: 4/4/2013 Edit: (Intubation, endotracheal, emergency procedure), (Laryngoscopy, indirect diagnostic), (Laryngoscopy, direct, with or without tracheoscopy for aspiration), (Laryngoscopy, direct with or without tracheoscopy; with insertion of obturator), (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed diagnostic, with cell washing, when performed), (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial (e.g., drainage of lung abscess), (Introduction of needle or intracatheter, vein), (Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein), (Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; scalp vein), (Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; other vein), (Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional, for diagnostic or therapeutic purposes {not to be used for routine venipuncture}), (Collection of venous blood by venipuncture), (Collection of capillary blood specimen {e.g., finger, heel, ear stick}), (Venipuncture cutdown, younger than age 1 year), (Venipuncture cutdown, age 1 or over), (Transfusion, blood or blood components) (Push transfusion, blood 2 year or younger), (Gastric intubation and aspiration(s) therapeutic, necessitating physician s skill {e.g., for gastrointestinal hemorrhage}, including lavage if performed), (Gastric intubation and aspiration, diagnostic; single specimen {e.g., acid analysis), (Electrocardiogram, routine ECGT with at least 12 leads; with interpretation and report), (Electrocardiogram, routine ECGT with at least 12 leads; tracing only; without interpretation and report), (Electrocardiogram, routine ECGT with at least 12 leads; interpretation and report only), (Rhythm ECG, 1-3 leads; with interpretation and report), (Rhythm ECG, 1-3 leads; tracing only without interpretation and report), (Rhythm ECG, 1-3 leads; interpretation and report only), (Transthoracic echocardiography for congenital cardiac anomalies; complete), (Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study), (Echocardiography, transthoracic, real-time with image documentation {2D}, includes M-mode recording, when performed, complete, without spectral or color Doppler Page 1 of 4
2 echocardiography), (Echocardiography, transthoracic, real-time with image documentation {2D}, includes M-mode recording, when performed, follow-up or limited study), (Echocardiography, transesophageal, real-time with image documentation {2D}{with or without M-mode recording}; including probe placement, image acquisition, interpretation and report), (Echocardiography, transesophageal, real-time with image documentation {2D}{with or without M-mode recording}; placement of transesophageal probe only), (Echocardiography, transesophageal, real-time with image documentation {2D}{with or without M-mode recording}; image acquisition, interpretation and report only), (Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report), (Transesophageal echocardiography for congenital cardiac anomalies; placement of transesophageal probe only), (Transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report only),94150 (Vital capacity, total), (94640 (Pressurized nor nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes {e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing {IPPB} device), (Noninvasive ear or pulse oximetry for oxygen saturation; single determination), (Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations {e.g., during exercise}), (Carbon dioxide, expired gas determination by infrared analyzer), (Electroencephalogram {EEG} extended monitoring; minutes), (Electroencephalogram {EEG} extended monitoring; greater than 1 hour), (Electroencephalogram {EEG} during nonintracranial surgery {e.g., carotid surgery}), (Intravenous infusion, for therapy, prophylaxis or diagnosis {specify substance or drug}; initial, up to 1 hour), (Intravenous infusion, for therapy, prophylaxis or diagnosis {specify substance or drug}; each additional hour), (Intravenous infusion, for therapy, prophylaxis or diagnosis {specify substance or drug}; additional sequential infusion of a new drug/substance, up to 1 hour), (Intravenous infusion, for therapy, prophylaxis or diagnosis {specify substance or drug}; concurrent infusion), (Subcutaneous infusion for therapy or prophylaxis {specify substance or drug}; initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s)), (Subcutaneous infusion for therapy or prophylaxis {specify substance or drug}; each additional hour), (Subcutaneous infusion for therapy or prophylaxis {specify substance or drug}; additional pump set-up with establishment of new subcutaneous infusion site(s)), (Therapeutic, prophylactic or diagnostic injection {specify substance or drug}; subcutaneous or intramuscular) bundles into (Anesthesia services) CODE RULE CODE Incidental Page 2 of 4
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4 Rationale for Edit: Anthem Central Region bundles , 31527, 31622, 31645, 36000, , , , , , , 94250, 94640, , , 95955, , as incidental to anesthesia services Based on the National Correct Coding Initiative Edits, codes , 31527, 31622, 31645, 36000, , , , , , , 94250, 94640, , , 95955, , are listed as component codes to codes Therefore, if , 31527, 31622, 31645, 36000, , , , , , , 94250, 94640, , , 95955, , is submitted with only reimburses. References: 1. Centers for Medicare and Medicaid (January 1, 2013-March 31, 2013) National Correct Coding Initiative Edits Version Retrieved March 26, 2013 from the World Wide Web: Coding-Edits.html Page 4 of 4
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Chapter 7 Assisting the ALS Provider Slide 1 Overview The Team Concept ALS Procedures and Equipment Electrocardiogram (ECG) Monitoring Slide 2 The Team Concept Prehospital care involves many individuals