CCI Bundling Anesthesia Edits

Principles of Medicare coding for anesthesia services involving administration of anesthesia are reported by the use of the anesthesia five-digit CPT procedure codes (00100-01860). These codes specify Anesthesia for followed by a general area of surgical intervention. When the following CPT codes are reported with an anesthesia code, it is assumed that these services are being reported as part of the anesthesia service and so will not be paid in addition to the anesthesia code. Because it is recognized that many of these procedures may occur on the same date of surgery but are not performed in the course of and as part of the anesthesia provision for the day, these codes will be separately paid only if the -59 modifier is appended to the code, indicating that the service rendered was independent of the anesthesia service.

An encounter with CPT 11200 and 10060 codes displays on the Claim Production Status report with the following claim edit.

Many of these procedures may occur on the same date of surgery but are not performed in the course of and as part of the anesthesia provision for the day. These codes will be separately paid only if the -59 modifier is appended to the code, indicating that the service rendered was independent of the anesthesia service.

Once the -59 modifier is added to the above charge on the encounter, the edit is removed as the combination of 11200 and 10060 is a valid combination with the -59 modifier.