NOTICES
Medical Assistance Program Fee Schedule Revisions; Addition of Procedure Codes and Change in Payment Methodology for Anesthesia Services
[34 Pa.B. 4780] The purpose of this notice is to announce that the Department of Public Welfare (Department) will add procedure codes for anesthesia services to the Medical Assistance (MA) Program fee schedule and change the payment methodology for those services in the Fee-for-Service Program (program). The changes are effective with dates of service on and after July 1, 2004.
The procedure codes are being added to comply with Title II of the Health Insurance Portability and Accountability Act, and accompanying regulations, which require that the MA Program adopt national code sets for all procedures. See 42 U.S.C.A. §§ 1320d--1320d-8 and 45 CFR 160.101--160.312 and 162.1000--62.1011. The new procedure codes will also more accurately reflect the manner in which anesthesia care is delivered. To pay claims for the new procedure codes in the program, the Department will adopt a payment methodology that conforms to the Medicare method of reimbursement. The payment methodology was developed in consultation with the Pennsylvania Medical Society and the Pennsylvania Society of Anesthesiologists.
Methodology
To establish the fees for the new procedure codes for anesthesiology services, the Department will utilize 100% of the Pennsylvania-specific Medicare 2004 conversion factor, which is $17.04. Fees will be established using the following pricing formula: (base unit assigned to each procedure code × conversion factor) + (conversion factor × time units). For select obstetrical anesthesia services (procedure codes 01960, 01961, 01962, 01963 and 01967), the Department will use the same pricing formula but will adjust the base units by adding four units to the Medicare base units, to account for the particular manner in which these services are provided.
When submitting claims for payment, providers will report the time the procedure began and the time the procedure ended, in accordance with the Medicare definition of ''anesthesia time.'' Anesthesia time is defined as the time during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services and ends when the anesthesia practitioner is no longer in personal attendance--that is, when the patient may safely be placed under postoperative supervision. See 42 CFR 414.46(a)(3). In the event that a surgery is cancelled following the beginning of anesthesia time, the anesthesiologist should report the actual number of minutes spent with the patient.
The Department will continue to pay for multiple surgeries in accordance with 55 Pa. Code § 1150.52(c) (relating to anesthesia services).
The new procedure codes for anesthesia services are as follows. The Department will publish the fees for the new procedure codes in an MA Bulletin that will be issued to providers before the effective date of the changes announced in this notice.
Fiscal Impact
The fiscal impact as a result of these changes is estimated at $1.536 million in total funds ($0.705 million in State funds and $0.831 million in Federal funds) for Fiscal Year 2004-2005. The estimated cost for Fiscal Year 2005-2006 is $1.843 million in total funds ($0.851 million in State funds and $0.992 million in Federal funds).
Public Comment
Interested persons are invited to submit written comments to this notice within 30 days of this publication to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Persons with a disability may use the AT&T Relay Service, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users). Comments will be considered in subsequent revisions to the fee schedule.
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-395. (1) General Fund; (2) Implementing Year 2004-05 is $705,000; (3) 1st Succeeding Year 2005-06 is $851,000; 2nd Succeeding Year 2006-07 is $851,000; 3rd Succeeding Year 2007-08 is $851,000; 4th Succeeding Year 2008-09 is $851,000; 5th Succeeding Year 2009-10 is $851,000; (4) 2003-04 Program--$727,979,000; 2002-03 Program--$666,832,000; 2001-02 Program--$705,750,000; (7) Medical Assistance--Outpatient; (8) recommends adoption. The costs outlined have been included in the General Appropriation Act of 2004 (Act 7A).
Anesthesia Procedure Codes Chart--2004
Code Description (CPT)
Base Units Place of Service PVR Type 00100 Anesthesia for procedures on salivary glands, including biopsy 5 21, 24 31, 32 00102 Anesthesia for procedures on plastic repair of cleft lip 6 21, 24 31, 32 00103 Anesthesia for reconstructive procedures of eyelid (for example, blepharoplasty, ptosis surgery) 5 21, 24 31, 32 00104 Anesthesia for electroconvulsive therapy 4 21, 24 31, 32 00120 Anesthesia for procedures on external, middle and inner ear including biopsy; not otherwise specified 5 21, 24 31, 32 00124 Anesthesia for procedures on external, middle and inner ear including biopsy; otoscopy 4 21, 24 31, 32 00126 Anesthesia for procedures on external, middle and inner ear including biopsy; tympanotomy 4 21, 24 31, 32 00140 Anesthesia for procedures on eye; not otherwise specified 5 21, 24 31, 32 00142 Anesthesia for procedures on eye; lens surgery 4 21, 24 31, 32 00144 Anesthesia for procedures on eye; corneal transplant 6 21, 24 31, 32 00145 Anesthesia for procedures on eye; vitreoretinal surgery 6 21, 24 31, 32 00147 Anesthesia for procedures on eye; iridectomy 4 21, 24 31, 32 00148 Anesthesia for procedures on eye; ophthalmoscopy 4 21, 24 31, 32 00160 Anesthesia for procedures on nose and accessory sinuses; not otherwise specified 5 21, 24 31, 32 00162 Anesthesia for procedures on nose and accessory sinuses; radical surgery 7 21, 24 31, 32 00164 Anesthesia for procedures on nose and accessory sinuses; biopsy, soft tissue 4 21, 24 31, 32 00170 Anesthesia for intraoral procedures, including biopsy; not otherwise specified 5 21, 24 31, 32 00172 Anesthesia for intraoral procedures, including biopsy; repair of cleft palate 6 21, 24 31, 32 00174 Anesthesia for intraoral procedures, including biopsy; excision of retropharyngeal tumor 6 21, 24 31, 32 00176 Anesthesia for intraoral procedures, including biopsy; radical surgery 7 21, 24 31, 32 00190 Anesthesia for procedures on facial bones or skull; not otherwise specified 5 21, 24 31, 32 00192 Anesthesia for procedures on facial bones or skull; radical surgery (including prognathism) 7 21, 24 31, 32 00210 Anesthesia for intracranial procedures; not otherwise specified 11 21 31, 32 00212 Anesthesia for intracranial procedures; subdural taps 5 21 31, 32 00214 Anesthesia for intracranial procedures; burr holes, including ventriculography 9 21 31, 32 00215 Anesthesia for intracranial procedures; cranioplasty or elevation of depressed skull fracture, extradural (simple or compound) 9 21 31, 32 00216 Anesthesia for intracranial procedures; vascular procedures 15 21 31, 32 00218 Anesthesia for intracranial procedures; procedures in sitting position 13 21 31, 32 00220 Anesthesia for intracranial procedures; cerebrospinal fluid shunting procedures 10 21 31, 32 00222 Anesthesia for intracranial procedures; electrocoagulation of intracranial nerve 6 21 31, 32 00300 Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck and posterior trunk, not otherwise specified 5 21, 24 31, 32 00320 Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; not otherwise specified, age 1 year or older 6 21, 24 31, 32 00322 Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; needle biopsy of thyroid 3 21, 24 31, 32 00326 Anesthesia for all procedures on the larynx and trachea in children less than 1 year of age 7 21, 24 31, 32 00350 Anesthesia for procedures on major vessels of neck; not otherwise specified 10 21 31, 32 00352 Anesthesia for procedures on major vessels of neck; simple ligation 5 21 31, 32 00400 Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified 3 21, 24 31, 32 00402 Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; reconstructive procedures on breast (for example, reduction or augmentation mammoplasty, muscle flaps) 5 21, 24 31, 32 00404 Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast 5 21, 24 31, 32 00406 Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast with internal mammary node dissection 13 21, 24 31, 32 00410 Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; electrical conversion of arrhythmias 4 21, 24 31, 32 00450 Anesthesia for procedures on clavicle and scapula; not otherwise specified 5 21, 24 31, 32 00452 Anesthesia for procedures on clavicle and scapula; radical surgery 6 21 31, 32 00454 Anesthesia for procedures on clavicle and scapula; biopsy of clavicle 3 21, 24 31, 32 00470 Anesthesia for partial rib resection; not otherwise specified 6 21 31, 32 00472 Anesthesia for partial rib resection; thoracoplasty (any type) 10 21 31, 32 00474 Anesthesia for partial rib resection; radical procedures (for example, pectus excavatum) 13 21 31, 32 00500 Anesthesia for all procedures on esophagus 15 21, 24 31, 32 00520 Anesthesia for closed chest procedures; (including bronchoscopy) not otherwise specified 6 21, 24 31, 32 00522 Anesthesia for closed chest procedures; needle biopsy of pleura 4 21, 24 31, 32 00524 Anesthesia for closed chest procedures; pneumocentesis 4 21, 24 31, 32 00528 Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy not utilizing one lung ventilation 8 21, 24 31, 32 00529 Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracosopy utilizing one lung ventilation 11 21 31, 32 00530 Anesthesia for permanent transvenous pacemaker insertion 4 21, 24 31, 32 00532 Anesthesia for access to central venous circulation 4 21, 24 31, 32 00534 Anesthesia for transvenous insertion or replacement of pacing cardioverter/defibrillator 7 21, 24 31, 32 00537 Anesthesia for cardiac electrophysiologic procedures including radiofrequency ablation 7 21, 24 31, 32 00539 Anesthesia for tracheobronchial reconstruction 18 21 31, 32 00540 Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm and mediastinum (including surgical thorascoscopy); not otherwise specified 12 21 31, 32 00541 Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm and mediastinum (including surgical thorascoscopy); utilizing one lung ventilation 15 21 31, 32 00542 Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm and mediastinum (including surgical thorascoscopy); decortication 15 21 31, 32 00546 Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm and mediastinum (including surgical thorascoscopy); pulmonary resection with thoracoplasty 15 21 31, 32 00548 Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm and mediastinum (including surgical thorascoscopy); intrathoracic procedures on the trachea and bronchi 17 21 31, 32 00550 Anesthesia for sternal debridement 10 21 31, 32 00560 Anesthesia for procedures on heart, pericardial sac and great vessels of chest; without pump oxygenator 15 21 31, 32 00562 Anesthesia for procedures on heart, pericardial sac and great vessels of chest; with pump oxygenator 20 21 31, 32 00563 Anesthesia for procedures on heart, pericardial sac and great vessels of chest; with pump oxygenator with hypothermic circulatory arrest 25 21 31, 32 00566 Anesthesia for direct coronary artery bypass grafting without pump oxygenator 25 21 31, 32 00580 Anesthesia for heart transplant or heart/lung transplant 20 21 31, 32 00600 Anesthesia for procedures on cervical spine and cord; not otherwise specified 10 21, 24 31, 32 00604 Anesthesia for procedures on cervical spine and cord; procedures with patient in the sitting position 13 21, 24 31, 32 00620 Anesthesia for procedures on thoracic spine and cord; not otherwise specified 10 21, 24 31, 32 00622 Anesthesia for procedures on thoracic spine and cord; thoracolumbar sympathectomy 13 21, 24 31, 32 00630 Anesthesia for procedures in lumbar region; not otherwise specified 8 21, 24 31, 32 00632 Anesthesia for procedures in lumbar region; lumbar sympathectomy 7 21, 24 31, 32 00634 Anesthesia for procedures in lumbar region; chemonucleolysis 10 21, 24 31, 32 00635 Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture 4 21, 24 31, 32 00640 Anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic or lumbar spine 3 21, 24 31, 32 00670 Anesthesia for extensive spine and spinal cord procedures (for example, spinal instrumentation or vascular procedures) 13 21 31, 32 00700 Anesthesia for procedures on upper anterior abdominal wall; not otherwise specified 4 21, 24 31, 32 00702 Anesthesia for procedures on upper anterior abdominal wall; percutaneous liver biopsy 4 21, 24 31, 32 00730 Anesthesia for procedures on upper posterior abdominal wall 5 21, 24 31, 32 00740 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum 5 21, 24 31, 32 00750 Anesthesia for hernia repairs in upper abdomen; not otherwise specified 4 21, 24 31, 32 00752 Anesthesia for hernia repairs in upper abdomen; lumbar and ventral (incisional) hernias and/or wound dehiscence 6 21, 24 31, 32 00754 Anesthesia for hernia repairs in upper abdomen; omphalocele 7 21, 24 31, 32 00756 Anesthesia for hernia repairs in upper abdomen; transabdominal repair of diaphragmatic hernia 7 21, 24 31, 32 00770 Anesthesia for all procedures on major abdominal blood vessels 15 21 31, 32 00790 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified 7 21, 24 31, 32 00792 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; partial hepatectomy or management of liver hemorrhage (excluding liver biopsy) 13 21 31, 32 00794 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; pancreatectomy, partial or total (for example, Whipple procedure) 8 21 31, 32 00796 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; liver transplant (recipient) 30 21 31, 32 00797 Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity 8 21 31, 32 00800 Anesthesia for procedures on lower anterior abdominal wall; not otherwise specified 4 21, 24 31, 32 00802 Anesthesia for procedures on lower anterior abdominal wall; panniculectomy 5 21, 24 31, 32 00810 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum 5 21, 24 31, 32 00820 Anesthesia for procedures on lower posterior abdominal wall 5 21, 24 31, 32 00830 Anesthesia for hernia repairs in lower abdomen; not otherwise specified 4 21, 24 31, 32 00832 Anesthesia for hernia repairs in lower abdomen; ventral and incisional hernias 6 21, 24 31, 32 00834 Anesthesia for hernia repairs in the lower abdomen not otherwise specified, under 1 year of age 5 21, 24 31, 32 00836 Anesthesia for hernia repairs in the lower abdomen not otherwise specified, infants less than 37 weeks gestational age at birth and less than 50 weeks gestational age at time of surgery 6 21, 24 31, 32 00840 Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified 6 21, 24 31, 32 00842 Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; amniocentesis 4 21, 24 31, 32 00844 Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; abdominoperineal resection 7 21 31, 32 00846 Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; radical hysterectomy 8 21 31, 32 00848 Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; pelvic exenteration 8 21 31, 32 00851 Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection 6 21, 24 31, 32 00860 Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; not otherwise specified 6 21, 24 31, 32 00862 Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper 1/3 of ureter or donor nephrectomy 7 21, 24 31, 32 00864 Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; total cystectomy 8 21 31, 32 00865 Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; radical prostatectomy (suprapubic, retropubic) 7 21 31, 32 00866 Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; adrenalectomy 10 21 31, 32 00868 Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal transplant (recipient) 10 21 31, 32 00870 Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; cystolithotomy 5 21, 24 31, 32 00872 Anesthesia for lithotripsy, extracorporeal shock wave; with water bath 7 21, 24 31, 32 00873 Anesthesia for lithotripsy, extracorporeal shock wave; without water bath 5 21, 24 31, 32 00880 Anesthesia for procedures on major lower abdominal vessels; not otherwise specified 15 21 31, 32 00882 Anesthesia for procedures on major lower abdominal vessels; inferior vena cava ligation 10 21 31, 32 00902 Anesthesia for; anorectal procedure 5 21, 24 31, 32 00904 Anesthesia for; radical perineal procedure 7 21 31, 32 00906 Anesthesia for; vulvectomy 4 21 31, 32 00908 Anesthesia for; perineal prostatectomy 6 21 31, 32 00910 Anesthesia for transurethral procedures (including urethrocystoscopy); not otherwise specified 3 21, 24 31, 32 00912 Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of bladder tumors 5 21, 24 31, 32 00914 Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of prostate 5 21, 24 31, 32 00916 Anesthesia for transurethral procedures (including urethrocystoscopy); post-transurethral resection bleeding 5 21, 24 31, 32 00918 Anesthesia for transurethral procedures (including urethrocystoscopy); with fragmentation, manipulation and/or removal of ureteral calculus 5 21, 24 31, 32 00920 Anesthesia for procedures on male genitalia (including open urethral procedures); not otherwise specified 3 21, 24 31, 32 00921 Anesthesia for procedures on male genitalia (including open urethral procedures); vasectomy, unilateral/bilateral 3 21, 24 31, 32 00922 Anesthesia for procedures on male genitalia (including open urethral procedures); seminal vesicles 6 21, 24 31, 32 00924 Anesthesia for procedures on male genitalia (including open urethral procedures); undescended testis, unilateral or bilateral 4 21, 24 31, 32 00926 Anesthesia for procedures on male genitalia (including open urethral procedures); radical orchiectomy, inguinal 4 21 31, 32 00928 Anesthesia for procedures on male genitalia (including open urethral procedures); radical orchiectomy, abdominal 6 21 31, 32 00930 Anesthesia for procedures on male genitalia (including open urethral procedures); orchiopexy, unilateral or bilateral 4 21, 24 31, 32 00932 Anesthesia for procedures on male genitalia (including open urethral procedures); complete amputation of penis 4 21, 24 31, 32 00934 Anesthesia for procedures on male genitalia (including open urethral procedures); radical amputation of penis with bilateral inguinal lymphadenectomy 6 21 31, 32 00936 Anesthesia for procedures on male genitalia (including open urethral procedures); radical amputation of penis with bilateral inguinal and iliac lymphadenectomy 8 21 31, 32 00938 Anesthesia for procedures on male genitalia (including open urethral procedures); insertion of penile prosthesis (perineal approach) 4 21, 24 31, 32 00940 Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified 3 21, 24 31, 32 00942 Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); colpotomy, vaginectomy, colporrhaphy and open urethral procedures 4 21 31, 32 00944 Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); vaginal hysterectomy 6 21, 24 31, 32 00948 Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); cervical cerclage 4 21, 24 31, 32 00950 Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); culdoscopy 5 21, 24 31, 32 00952 Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); hysteroscopy and/or hysterosalpingography 4 21, 24 31, 32 01112 Anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest 5 21, 24 31, 32 01120 Anesthesia for procedures on bony pelvis 6 21, 24 31, 32 01130 Anesthesia for body cast application or revision 3 21, 24 31, 32 01140 Anesthesia for interpelviabdominal (hindquarter) amputation 15 21 31, 32 01150 Anesthesia for radical procedures for tumor of pelvis, except hindquarter amputation 10 21 31, 32 01160 Anesthesia for closed procedures involving symphysis pubis or sacroiliac joint 4 21, 24 31, 32 01170 Anesthesia for open procedures involving symphysis pubis or sacroiliac joint 8 21 31, 32 01173 Anesthesia for open repair of fracture disruption of pelvis or column fracture involving acetabulum 12 21 21 31 32 01180 Anesthesia for obturator neurectomy; extrapelvic 3 21, 24 31, 32 01190 Anesthesia for obturator neurectomy; intrapelvic 4 21, 24 31, 32 01200 Anesthesia for all closed procedures involving hip joint 4 21, 24 31, 32 01202 Anesthesia for arthroscopic procedures of hip joint 4 21, 24 31, 32 01210 Anesthesia for open procedures involving hip joint; not otherwise specified 6 21 31, 32 01212 Anesthesia for open procedures involving hip joint; hip disarticulation 10 21 31, 32 01214 Anesthesia for open procedures involving hip joint; total hip arthroplasty 8 21 31, 32 01215 Anesthesia for open procedures involving hip joint; revision of total hip arthroplasty 10 21 31, 32 01220 Anesthesia for all closed procedures involving upper 2/3 of femur 4 21, 24 31, 32 01230 Anesthesia for open procedures involving upper 2/3 of femur; not otherwise specified 6 21 31, 32 01232 Anesthesia for open procedures involving upper 2/3 of femur; amputation 5 21 31, 32 01234 Anesthesia for open procedures involving upper 2/3 of femur; radical resection 8 21 31, 32 01250 Anesthesia for all procedures on nerves, muscles, tendons, fascia and bursa of upper leg 4 21, 24 31, 32 01260 Anesthesia for all procedures involving veins of upper leg, including exploration 3 21, 24 31, 32 01270 Anesthesia for procedures involving arteries of upper leg, including bypass graft; not otherwise specified 8 21 31, 32 01272 Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery ligation 4 21 31, 32 01274 Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery embolectomy 6 21 31, 32 01320 Anesthesia for all procedures on nerves, muscles, tendons, fascia and bursa of knee and/or popliteal area 4 21, 24 31, 32 01340 Anesthesia for all closed procedures on lower 1/3 of femur 4 21, 24 31, 32 01360 Anesthesia for all open procedures on lower 1/3 of femur 5 21 31, 32 01380 Anesthesia for all closed procedures on knee joint 3 21, 24 31, 32 01382 Anesthesia for diagnostic arthroscopic procedures of knee joint 3 21, 24 31, 32 01390 Anesthesia for all closed procedures on upper ends of tibia, fibula and/or patella 3 21, 24 31, 32 01392 Anesthesia for all open procedures on upper ends of tibia, fibula and/or patella 4 21, 24 31, 32 01400 Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified 4 21, 24 31, 32 01402 Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty 7 21 31, 32 01404 Anesthesia for open or surgical arthroscopic procedures on knee joint; disarticulation at knee 5 21, 24 31, 32 01420 Anesthesia for all cast applications, removal or repair involving knee joint 3 21, 24 31, 32 01430 Anesthesia for procedures on veins of knee and popliteal area; not otherwise specified 3 21, 24 31, 32 01432 Anesthesia for procedures on veins of knee and popliteal area; arteriovenous fistula 6 21 31, 32 01440 Anesthesia for procedures on arteries of knee and popliteal area; not otherwise specified 8 21 31, 32 01442 Anesthesia for procedures on arteries of knee and popliteal area; popliteal thromboendarterectomy, with or without patch graft 8 21 31, 32 01444 Anesthesia for procedures on arteries of knee and popliteal area; popliteal excision and graft or repair for occlusion or aneurysm 8 21 31, 32 01462 Anesthesia for all closed procedures on lower leg, ankle and foot 3 21, 24 31, 32 01464 Anesthesia for arthroscopic procedures of ankle and/or foot 3 21, 24 31, 32 01470 Anesthesia for procedures on nerves, muscles, tendons and fascia of lower leg, ankle and foot; not otherwise specified 3 21, 24 31, 32 01472 Anesthesia for procedures on nerves, muscles, tendons and fascia of lower leg, ankle and foot; repair of ruptured Achilles tendon, with or without graft 5 21, 24 31, 32 01474 Anesthesia for procedures on nerves, muscles, tendons and fascia of lower leg, ankle and foot; gastrocnemius recession (for example, Strayer procedure) 5 21, 24 31, 32 01480 Anesthesia for open procedures on bones of lower leg, ankle and foot; not otherwise specified 3 21, 24 31, 32 01482 Anesthesia for open procedures on bones of lower leg, ankle and foot; radical resection (including below knee amputation) 4 21 31, 32 01484 Anesthesia for open procedures on bones of lower leg, ankle and foot; osteotomy or osteoplasty of tibia and/or fibula 4 21 31, 32 01486 Anesthesia for open procedures on bones of lower leg, ankle and foot; total ankle replacement 7 21 31, 32 01490 Anesthesia for lower leg cast application, removal or repair 3 21, 24 31, 32 01500 Anesthesia for procedures on arteries of lower leg, including bypass graft; not otherwise specified 8 21 31, 32 01502 Anesthesia for procedures on arteries of lower leg, including bypass graft; embolectomy, direct or catheter 6 21 31, 32 01520 Anesthesia for procedures on veins of lower leg; not otherwise specified 3 21, 24 31, 32 01522 Anesthesia for procedures on veins of lower leg; venous thrombectomy, direct or catheter 5 21, 24 31, 32 01610 Anesthesia for all procedures on nerves, muscles, tendons, fascia and bursa of shoulder and axilla 5 21, 24 31, 32 01620 Anesthesia for all closed procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint and shoulder joint 4 21, 24 31, 32 01622 Anesthesia for diagnostic arthroscopic procedures of shoulder joint 4 21, 24 31, 32 01630 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint and shoulder joint; not otherwise specified 5 21, 24 31, 32 01632 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint and shoulder joint; radical resection 6 21 31, 32 01634 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint and shoulder joint; shoulder disarticulation 9 21 31, 32 01636 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint and shoulder joint; interthoracoscapular (forequarter) amputation 15 21 31, 32 01638 Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint and shoulder joint; total shoulder replacement 10 21 31, 32 01650 Anesthesia for procedures on arteries of shoulder and axilla; not otherwise specified 6 21 31, 32 01652 Anesthesia for procedures on arteries of shoulder and axilla; axillary-brachial aneurysm 10 21 31, 32 01654 Anesthesia for procedures on arteries of shoulder and axilla; bypass graft 8 21 31, 32 01656 Anesthesia for procedures on arteries of shoulder and axilla; axillary-femoral bypass graft 10 21 31, 32 01670 Anesthesia for all procedures on veins of shoulder and axilla 4 21, 24 31, 32 01680 Anesthesia for shoulder cast application, removal or repair; not otherwise specified 3 21, 24 31, 32 01682 Anesthesia for shoulder cast application, removal or repair; shoulder spica 4 21, 24 31, 32 01710 Anesthesia for procedures on nerves, muscles, tendons, fascia and bursa of upper arm and elbow; not otherwise specified 3 21, 24 31, 32 01712 Anesthesia for procedures on nerves, muscles, tendons, fascia and bursa of upper arm and elbow; tenotomy, elbow to shoulder, open 5 21, 24 31, 32 01714 Anesthesia for procedures on nerves, muscles, tendons, fascia and bursa of upper arm and elbow; tenoplasty, elbow to shoulder 5 21, 24 31, 32 01716 Anesthesia for procedures on nerves, muscles, tendons, fascia and bursa of upper arm and elbow; tenodesis, rupture of long tendon of biceps 5 21 31, 32 01730 Anesthesia for all closed procedures on humerus and elbow 3 21, 24 31, 32 01732 Anesthesia for diagnostic arthroscopic procedures of elbow joint 3 21, 24 31, 32 01740 Anesthesia for open or surgical arthroscopic procedures of the elbow; not otherwise specified 4 21, 24 31, 32 01742 Anesthesia for open or surgical arthroscopic procedures of the elbow; osteotomy of humerus 5 21, 24 31, 32 01744 Anesthesia for open or surgical arthroscopic procedures of the elbow; repair of nonunion or malunion of humerus 5 21, 24 31, 32 01756 Anesthesia for open or surgical arthroscopic procedures of the elbow; radical procedures 6 21, 24 31, 32 01758 Anesthesia for open or surgical arthroscopic procedures of the elbow; excision of cyst or tumor of humerus 5 21, 24 31, 32 01760 Anesthesia for open or surgical arthroscopic procedures of the elbow; total elbow replacement 7 21 31, 32 01770 Anesthesia for procedures on arteries of upper arm and elbow; not otherwise specified 6 21, 24 31, 32 01772 Anesthesia for procedures on arteries of upper arm and elbow; embolectomy 6 21, 24 31, 32 01780 Anesthesia for procedures on veins of upper arm and elbow; not otherwise specified 3 21, 24 31, 32 01782 Anesthesia for procedures on veins of upper arm and elbow; phleborrhaphy 4 21, 24 31, 32 01810 Anesthesia for all procedures on nerves, muscles, tendons, fascia and bursa of forearm, wrist and hand 3 21, 24 31, 32 01820 Anesthesia for all closed procedures on radius, ulna, wrist or hand bones 3 21, 24 31, 32 01829 Anesthesia for diagnostic arthroscopic procedures on the wrist 3 21, 24 31, 32 01830 Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist or hand joints; not otherwise specified 3 21, 24 31, 32 01832 Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist or hand joints; total wrist replacement 6 21, 24 31, 32 01840 Anesthesia for procedures on arteries of forearm, wrist and hand; not otherwise specified 6 21, 24 31, 32 01842 Anesthesia for procedures on arteries of forearm, wrist and hand; embolectomy 6 21, 24 31, 32 01844 Anesthesia for vascular shunt or shunt revision, any type (for example, dialysis) 6 21, 24 31, 32 01850 Anesthesia for procedures on veins of forearm, wrist and hand; not otherwise specified 3 21, 24 31, 32 01852 Anesthesia for procedures on veins of forearm, wrist and hand; phleborrhaphy 4 21, 24 31, 32 01860 Anesthesia for forearm, wrist or hand cast application, removal or repair 3 21, 24, 99 31, 32 01905 Anesthesia for myelography, diskography, vertebroplasty 5 21, 24, 99 31, 32 01916 Anesthesia for diagnostic arteriography/venography 5 21, 24, 99 31, 32 01920 Anesthesia for cardiac catheterization including coronary angiography and ventriculography (not to include Swan-Ganz catheter) 7 21, 24, 99 31, 32 01922 Anesthesia for non-invasive imaging or radiation therapy 7 21, 24, 99 31, 32 01924 Anesthesia for therapeutic interventional radiologic procedures involving the arterial system; not otherwise specified 5 21, 24, 99 31, 32 01925 Anesthesia for therapeutic interventional radiologic procedures involving the arterial system; carotid or coronary 7 21, 24, 99 31, 32 01926 Anesthesia for therapeutic interventional radiologic procedures involving the arterial system; intracranial, intracardiac or aortic 8 21, 24, 99 31, 32 01930 Anesthesia for therapeutic interventional radiologic procedures involving the venous/lymphatic system (not to include access to the central circulation); not otherwise specified 5 21, 24, 99 31, 32 01931 Anesthesia for therapeutic interventional radiologic procedures involving the venous/lymphatic system (not to include access to the central circulation); intrahepatic or portal circulation (for example, transcutaneous porto-caval shunt (TIPS)) 7 21, 24, 99 31, 32 01932 Anesthesia for therapeutic interventional radiologic procedures involving the venous/lymphatic system (not to include access to the central circulation); intrathoracic or jugular 6 21, 24, 99 31, 32 01933 Anesthesia for therapeutic interventional radiologic procedures involving the venous/lymphatic system (not to include access to the central circulation); intracranial 7 21, 24, 99 31, 32 01951 Anesthesia for second and third degree burn excision or debridement with or without skin grafting, any site, for TBSA treated during anesthesia and surgery; less than 4% TBSA 3 21, 24 31, 32 01952 Anesthesia for second and third degree burn excision or debridement with or without skin grafting, any site, for TBSA treated during anesthesia and surgery; between 4% and 9% of TBSA 5 21 31, 32 01953 Anesthesia for second and third degree burn excision or debridement with or without skin grafting, any site, for TBSA treated during anesthesia and surgery; each additional 9% TBSA or part thereof (list separately in addition to code for primary procedure) 1 21 31, 32 01958 Anesthesia for external cephalic version procedure 5 21, 24 31, 32 01960 Anesthesia for vaginal delivery only 9 21 31, 32 01961 Anesthesia for cesarean delivery only 11 21 31, 32 01962 Anesthesia for urgent hysterectomy following delivery 12 21 31, 32 01963 Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care 12 21 31, 32 01964 Anesthesia for abortion procedures 4 21, 24 31, 32 01967 Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor) 9 21 31, 32 01968 Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed) 2 21 31, 32 01969 Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed) 5 21 31, 32 01991 Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider); other than the prone position 3 21, 24 31, 32 01992 Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider); prone position 5 21, 24 31, 32
[Pa.B. Doc. No. 04-1612. Filed for public inspection August 27, 2004, 9:00 a.m.]
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