In a recent development for the anesthesia community, HealthDataInsights (“HDI”), the RAC for Region D, removed the anesthesia care package issue from its approved issues list. In January of 2010, the RAC vendor posted the following issue:
Under NCCI Edit rules, the anesthesia care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and post-anesthesia recovery care. Anesthesia CPT codes 00100 to 01999 (except 01996) include Evaluation & Management (E&M) services rendered on the day before anesthesia (pre-operative day), the day of the anesthesia and all post-operative days. CPT code 01996 includes E&M services on the same day as the 01996 service only. Physicians can indicate that E&M services rendered during the anesthesia period are unrelated to the anesthesia procedure by submitting modifiers 24, 25, 57 and/or 59, depending on claim specific circumstances, on the E&M service. Only critical care E&M services are payable during the anesthesia post-operative period. The post-operative period is defined as the day immediately following the anesthesia service and any subsequent days during the same inpatient hospital admission as for the anesthesia service.
Today, HLP partner Abby Pendleton noted that the issue was no longer posted on the approved issues list and spoke with the CMS RAC project coordinator for HDI, who confirmed that CMS directed the removal from HDI’s approved issues list. CMS couldn’t provide additional details about why this information has been removed, but anesthesia providers should stay tuned.
For more information about RACs, contact Abby Pendleton, Esq. at (248) 996-8510