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OHCA Policies and Rules

317:30-5-7. Anesthesia

[Revised 06-25-12]

(a) Procedure codes. Anesthesia codes from the Physicians' Current Procedural Terminology should be used. Payment is made only for the major procedure during an operative session.

(b) Modifiers. All anesthesia procedure codes must have a modifier. Without the modifier, the claim will be denied.

(c) Qualifying circumstances. Certain codes in the Medicine section of the CPT are used to identify extraordinary anesthesia services. The appropriate modifiers should be added to these codes. Additional payment can be made for extremes of age, total body hypothermia, and controlled hypertension.

(d) Hypothermia. Hypothermia total body or regional is not covered unless medical necessity is documented and approved through review by the Authority's Medical Consultants.

(e) Anesthesia with Blood Gas Analysis. Blood gas analysis is part of anesthesia service. Payment for anesthesia includes payment for blood gas analysis.

(f) Steroid injections. Steroid injections administered by an anesthesiologist are covered as nerve block. The appropriate CPT procedure code is used to bill services.

(g) Local anesthesia. If local anesthesia is administered by attending surgeon, payment is included in the global surgery fee, except for spinal or epidural anesthesia in conjunction with childbirth.

(h) Stand by anesthesia. This is not covered unless the physician is actually in the operating room administering medication, etc. If this is indicated, claim will be processed as if anesthesia was given. Use appropriate anesthesia code.

(i) Other qualifying circumstances. All other qualifying circumstances, i.e., physical status, emergency, etc. have been structured into the total allowable for the procedure.

(j) Central venous catheter and anesthesia. Payment for placement of central venous catheter, injection of anesthesia substance or similar procedures will be made only when the procedure is distinctly separate from the anesthesia procedure.

(k) Pain management. Pain management procedures performed during the anesthesia session will be covered when medically necessary to adequately control anticipated post-operative pain.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.