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: 9/20/2013-12/31/2099 Status: Current Last Review Date: 4/4/2013 Edit: 31500 (Intubation, endotracheal, emergency procedure), 31505 (Laryngoscopy, indirect diagnostic), 31515 (Laryngoscopy, direct, with or without tracheoscopy for aspiration), 31527 (Laryngoscopy, direct with or without tracheoscopy; with insertion of obturator), 31622 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed diagnostic, with cell washing, when performed), 31645 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial (e.g., drainage of lung abscess), 36000 (Introduction of needle or intracatheter, vein), 36400 (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), 36405 (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), 36406 (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), 36410 (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}), 36415 (Collection of venous blood by venipuncture), 36416 (Collection of capillary blood specimen {e.g., finger, heel, ear stick}), 36420 (Venipuncture cutdown, younger than age 1 year), 36425 (Venipuncture cutdown, age 1 or over), 36430 (Transfusion, blood or blood components) 36440 (Push transfusion, blood 2 year or younger), 43753 (Gastric intubation and aspiration(s) therapeutic, necessitating physician s skill {e.g., for gastrointestinal hemorrhage}, including lavage if performed), 43754 (Gastric intubation and aspiration, diagnostic; single specimen {e.g., acid analysis), 93000 (Electrocardiogram, routine ECGT with at least 12 leads; with interpretation and report), 93005 (Electrocardiogram, routine ECGT with at least 12 leads; tracing only; without interpretation and report), 93010 (Electrocardiogram, routine ECGT with at least 12 leads; interpretation and report only), 93040 (Rhythm ECG, 1-3 leads; with interpretation and report), 93041 (Rhythm ECG, 1-3 leads; tracing only without interpretation and report), 93042 (Rhythm ECG, 1-3 leads; interpretation and report only), 93303 (Transthoracic echocardiography for congenital cardiac anomalies; complete), 93304 (Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study), 93307 (Echocardiography, transthoracic, real-time with image documentation {2D}, includes M-mode recording, when performed, complete, without spectral or color Doppler Page 1 of 4
echocardiography), 93308 (Echocardiography, transthoracic, real-time with image documentation {2D}, includes M-mode recording, when performed, follow-up or limited study), 93312 (Echocardiography, transesophageal, real-time with image documentation {2D}{with or without M-mode recording}; including probe placement, image acquisition, interpretation and report), 93313 (Echocardiography, transesophageal, real-time with image documentation {2D}{with or without M-mode recording}; placement of transesophageal probe only), 93314 (Echocardiography, transesophageal, real-time with image documentation {2D}{with or without M-mode recording}; image acquisition, interpretation and report only), 93315 (Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report), 93316 (Transesophageal echocardiography for congenital cardiac anomalies; placement of transesophageal probe only), 93317 (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), 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination), 94761 (Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations {e.g., during exercise}), 94770 (Carbon dioxide, expired gas determination by infrared analyzer), 95812 (Electroencephalogram {EEG} extended monitoring; 41-60 minutes), 95813 (Electroencephalogram {EEG} extended monitoring; greater than 1 hour), 95955 (Electroencephalogram {EEG} during nonintracranial surgery {e.g., carotid surgery}), 96365 (Intravenous infusion, for therapy, prophylaxis or diagnosis {specify substance or drug}; initial, up to 1 hour), 96366 (Intravenous infusion, for therapy, prophylaxis or diagnosis {specify substance or drug}; each additional hour), 96367 (Intravenous infusion, for therapy, prophylaxis or diagnosis {specify substance or drug}; additional sequential infusion of a new drug/substance, up to 1 hour), 96368 (Intravenous infusion, for therapy, prophylaxis or diagnosis {specify substance or drug}; concurrent infusion), 96369 (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)), 96370 (Subcutaneous infusion for therapy or prophylaxis {specify substance or drug}; each additional hour), 96371 (Subcutaneous infusion for therapy or prophylaxis {specify substance or drug}; additional pump set-up with establishment of new subcutaneous infusion site(s)), 96372 (Therapeutic, prophylactic or diagnostic injection {specify substance or drug}; subcutaneous or intramuscular) bundles into 00100-01999 (Anesthesia services) CODE RULE CODE 31500 31505 31515 31527 31622 31645 36000 Incidental 00100-01999 Page 2 of 4
36400 36405 36406 36410 36415 36420 36425 36430 36440 93000 93005 93010 93040 93041 93042 93303 93304 93307 93308 93312 93313 93314 93315 93316 93317 94150 94640 94760 94761 94770 95812 95813 95955 96360 96361 96365 96366 96367 96368 96369 96370 96371 Page 3 of 4
96371 96372 Rationale for Edit: Anthem Central Region bundles 31500-31515, 31527, 31622, 31645, 36000, 36400-36440, 93000-93010, 93040-93042, 93303-93304, 93307-93308, 93312-93317, 94250, 94640, 94760-94761, 95812-95813, 95955, 96360-96361, 96366-96372 as incidental to anesthesia services 00100-01999. Based on the National Correct Coding Initiative Edits, codes 31500-31515, 31527, 31622, 31645, 36000, 36400-36440, 93000-93010, 93040-93042, 93303-93304, 93307-93308, 93312-93317, 94250, 94640, 94760-94761, 95812-95813, 95955, 96360-96361, 96366-96372 are listed as component codes to codes 00100-01999. Therefore, if 31500-31515, 31527, 31622, 31645, 36000, 36400-36440, 93000-93010, 93040-93042, 93303-93304, 93307-93308, 93312-93317, 94250, 94640, 94760-94761, 95812-95813, 95955, 96360-96361, 96366-96372 is submitted with 00100-01999 only 00100-01999 reimburses. References: 1. Centers for Medicare and Medicaid (January 1, 2013-March 31, 2013) National Correct Coding Initiative Edits Version 19.0. Retrieved March 26, 2013 from the World Wide Web: http://www.cms.gov/medicare/coding/nationalcorrectcodinited/ncci- Coding-Edits.html Page 4 of 4
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