Did you know that anesthesiology has one of the highest claim denial rates in the healthcare industry? Surveys have shown that insurance payers deny 19% of the claims submitted by anesthesiologists, whereas the average denial rate for all specialties combined is between 5% and 10%. So, what are the anesthesiologists doing wrong?
Let’s find out as we deep dive into the world of anesthesiology medical coding and unravel the do’s and don’ts of reporting CPT code 01922.
CPT Code 01922 – Description
The Current Procedural Terminology (CPT) code 01922 is from the code range that covers Anesthesia for Radiological Procedures. It explains the administration of general anesthesia on a patient intended to undergo non-invasive imaging or radiation therapies for diagnostic purposes like computed tomography (CT) or magnetic resonance imaging (MRI) scans.
The primary reason for sedating patients during these diagnostic imaging tests is to ensure they feel comfortable and remain still for accurate image capture. For example, children, adults with high anxiety, or claustrophobic/ mentally challenged patients are frequently sedated during MRI and CT scans to restrict their movement on the bed.
Medicare Part B covers anesthesia services provided in an outpatient setting. Hence, CPT code 01922 is covered by Medicare Part B. However, its reimbursement rate varies depending on the Medicare Administrative Contractor (MAC) locality and facility.
Scenarios Where CPT Code 01922 is Applicable
As we have mentioned above, some situations necessitate the provision of anesthesia services prior to non-invasive radiology procedures. We know that typically, anesthesia is administered when patients are expected to experience pain, for example, during surgeries.
However, in this case, general anesthesia is administered to sedate the patient, leaving them unaware of the procedure. It helps control the patient’s anxiety and mobility. Here are some specific examples where CPT code 01922 is most accurately applicable.
Sedating an Infant Undergoing MRI Scanning for Cerebral Palsy
Let’s assume that an 18-month-old infant with suspected cerebral palsy (a movement disorder that affects muscle control and posture) visits the diagnostic center with her parents. The child must undergo MRI scanning to detect signs of brain damage, such as lesions and other abnormalities. However, when the child is placed on the MRI bed, she starts crying and refuses to lie down, making it impossible for the technician to perform diagnostic imaging.
The technician requests a certified registered nurse anesthetist (CRNA) to administer general anesthesia to the infant so that she is heavily sedated (remains still) during the MRI scanning. Later, the CRNA will report CPT code 01922 for his anesthesia services.
Administering Anesthesia to a Claustrophobic Patient Before MRI Scanning
MRI machines can trigger a patient’s claustrophobia because of their enclosed space. The patient must lie still on the MRI bed for 30 to 60 minutes, during which their upper body is inside the enclosed space for scanning. Moreover, the noise from the MRI machine can be loud, exacerbating their anxiety. According to a study, the average global discontinuation rate for MRIs due to claustrophobia is between 1.2 % and 1.8 %, causing healthcare providers to lose billions of dollars in productivity.
However, sedating the patient during scanning makes them unaware of their surroundings, reducing their discomfort and alleviating the chances of procedure discontinuation.
Now, imagine that a 45-year-old man with a history of claustrophobia must undergo MRI scanning to detect possible brain injuries. He refuses the imaging because of the MRI machine’s enclosed space. An anesthesiologist is called in to sedate the patient and induce a deep sleep-like state. Once sedated, the technician performs MRI scanning without triggering the patient’s claustrophobia.
After the procedure is completed and the patient regains consciousness, the anesthesiologist will bill his services with CPT code 01922.
Sedating a Patient with Tourette Syndrome Before MRI Scanning
According to the U.S. Centers for Disease Control and Prevention (CDC)’s Data and Statistics on Tourette Syndrome, around 1 out of 162 children have Tourette syndrome (TS). Also, the prevalence of TS in boys is three times higher than in girls. TS is a neurological disorder that affects the normal functioning of the brain (particularly its motor cortex), resulting in involuntary and rapid tics.
Primary physicians sometimes order neuroimaging studies like MRI and CT scans to rule out other neurological conditions with symptoms similar to TS, such as ADHD, OCD, myoclonic epilepsy, or other tic disorders.
Now, assume that a 12-year-old boy with Tourette syndrome displays attention deficiency, hyperactivity, a lack of organizational skills, and forgetfulness. His physician suspects that the child may have ADHD with TS (the prevalence of both disorders occurring together is 52%). Therefore, he orders an MRI scan to observe the structural differences in his brain maps, e.g., an underdeveloped prefrontal cortex.
However, because of his Tourette syndrome and severe tics, the child is unable to control his movements and stay still on the MRI bed. Hence, an anesthesiologist is called and asked to administer general anesthesia so the patient remains sedated during the diagnostic imaging.
The anesthesiologist will report CPT code 01922 for his services on a separate claim form and submit it to the insurance payer for reimbursement.
Applicable Modifiers for CPT Code 01922
Let’s look at some modifiers that can be appended to CPT code 01922 for coding specificity.
Modifier 23
Modifier 23 reports general anesthesia administration under unusual circumstances or when an anesthesia service would generally not be required. For example, if general anesthesia is administered to a patient with Down syndrome or autism to increase their cooperation during the radiology procedure, modifier 23 will be appended to CPT code 01922.
Modifier 59
CPT code 01922 is frequently bundled with HCPCS codes like G0339 and G6003. However, if you want to unbundle the two procedures and collect a separate payment for your anesthesia services, you must append modifier 59 with CPT code 01922. It will indicate that the procedure was distinct from other services performed on the same day.
Modifier AA
Modifier AA can help you collect 100% reimbursement for your anesthesia services. It indicates that the anesthesia was administered personally by an anesthesiologist.
Modifier QS
Modifier QS is an HCPCS modifier. It explains that a qualified non-physician anesthetist or a physician offered monitored anesthesiology care services.
CPT Code 01922 – Billing & Reimbursement Guidelines
Just knowing which code to apply and which modifiers to append is not enough if you are seeking fair and speedy reimbursements for your anesthesia services. You must follow the payer-specific billing rules and guidelines to streamline the process, make it error-free, and reduce the chances of payment delays/denials.
Below, we have discussed some billing rules and reimbursement requirements specific to CPT code 01922. Take a look.
Use the Basic Equation to Calculate Payment for CPT 01922
CPT code 01922 is time-based. Anesthesiologists must report how long they monitored anesthesia care for a patient undergoing diagnostic imaging procedures or radiation therapy. They are paid according to the total time they spent administering anesthesia services to the patient. This is because their total billable amount is calculated using the Standard Anesthesia Formula, as shown below.
(Base Units + Timed Units) x Anesthesia Conversion Factor = Payment
For example, if an anesthesiologist spent 129 minutes with the patient and every 15-minute block equals 1 unit of service, the total Timed Units will be 8.6 (129 divided by 15).
Medicare and commercial payers have assigned CPT code 01922 the Base Unit Value of 7. Now, imagine that the Anesthesia Conversion Factor set by the State of Arizona is $61.00.
So, if we insert these values in the formula, our total payment or billed amount will be:
(7 + 8.6) x 61 = $951.6
Prove the Medical Necessity of Anesthesia Administration
You must also prove the medical necessity of administering general anesthesia before a radiology procedure like CT or MRI scanning.
For example, you must submit the patient’s complete medical history to explain that the patient was diagnosed with claustrophobia years ago, or your clinical notes must mention the observation of uncontrollable tics in the case of a patient with Tourette syndrome.
Maintain and Submit Comprehensive Documentation
Maintaining and submitting accurate and complete documentation will help you prove the medical necessity of administering anesthesia before diagnostic imaging procedures. This, in turn, will help you avoid claim denials as insurance payers are less likely to reject claims for medically necessary services.
Your documentation should include the reason for sedation, who administered anesthesia, which route or medication was used for sedation, how long the service lasted, and any complications or side effects that hindered the procedure.
Pair with the Accurate Radiology Procedure Code
Next, you must ensure that your anesthesia CPT code 01922 is paired with the relevant CPT or HCPCS code for the radiology procedure.
For example, if the anesthesia service was performed on a child to diagnose brain injuries through MRI without contrast, CPT code 01922 will be reported on one claim line and CPT code 70551 on the second claim line.
Follow Payer-Specific Billing Policies
Billing guidelines and reimbursement policies vary across the board – from Medicare to Medicaid and commercial insurance payers. What may be acceptable for one payer might not be allowed by the other. Therefore, it is essential that you thoroughly review each payer’s policies before reporting CPT code 01922. Staying informed and following instructions to a T will help you mitigate claim denials.
Summary
If your mind has turned into a cerebral cornucopia by now, let’s quickly revisit what we learned in this guide to leave you with the key takeaways. We discussed the descriptor for CPT code 01922 and understood that it highlights general anesthesia administration to a patient undergoing diagnostic imaging or radiation therapy.
The code is most applicable if the patient is an infant, claustrophobic, or suffers from a disorder that causes involuntary, repeated movements, like Tourette syndrome.
You may append modifiers like 23, 59, AA, and QS if needed. However, the best method to ensure accurate reimbursement against CPT code 01922 is to outsource anesthesia billing services to professionals like MediBillMD.
