Want to bill the anesthesia service for an intraoral procedure? Use CPT code 00170! Many intraoral procedures, such as dental treatments and surgical incisions, require the use of anesthesia. However, its coding, especially for dental procedures, confuses even the most seasoned professionals.
The common questions? Is anesthesia included in the procedure or should it be billed separately? Should the claim be submitted to a dental or medical insurer? And most importantly, which modifiers are applicable? If you also need answers to these questions, then you are at the right place. Stay with us as we discuss the 00170 CPT code in detail.
CPT Code 00170 – Description
CPT code 00170 falls within the anesthesia section for head procedures. To be more specific, it refers to the pain relief service during a wide range of intraoral procedures, including but not limited to:
- Surgical incision
- Bony impacted wisdom tooth removal
- Biopsy
In simple terms, healthcare providers, including anesthesiologists or Certified Registered Nurse Anesthetists (CRNAs), use this code to report that they have administered anesthesia to numb the mouth or oral cavity during one such procedure. The primary purpose? To increase the patient’s comfort and reduce pain and anxiety.
Scenarios Where CPT Code 00170 is Applicable
If you are still a bit lost about CPT code 00170, you can refer to the following scenarios:
Administration of General Anesthesia for Impacted Wisdom Tooth Removal
According to the American Academy of Oral and Maxillofacial Surgeons, 90% of people in the U.S. have at least one impacted wisdom tooth. Out of these, 65% of people opt for surgical removal, requiring the use of anesthesia.
So, for the first example, suppose a 24-year-old woman presents with severe horizontal impaction of her lower left third molar. The healthcare provider performs an examination and asks the patient about her symptoms, which include intense pain in the jaw and the back of the mouth, recurrent headaches, and earaches. The provider also notices inflamed gums and bad breath and orders several imaging tests.
After confirming the horizontal impaction, the oral surgeon recommends a surgical removal of the impacted molar. Before the procedure, an anesthesiologist is called in to administer general anesthesia, who reports the service using CPT code 00170.
Administering Anesthesia for Oral Biopsy
Oral cancer accounts for approximately 3% of all cancers in the U.S., with 30,000 new cases each year. Its primary symptom? Mouth ulcers. Healthcare providers perform a biopsy to diagnose this disease, which requires the use of anesthesia.
For this example, let’s consider a 42-year-old man with a bleeding mouth sore. He arrives at a hospital after enduring it for three weeks. The healthcare provider examines the patient’s mouth and notes that he also has difficulty speaking. He then refers him to an oral surgeon, who decides to remove the sore to check for oral cancer or any other disease.
Before the procedure, an anesthesiologist administers anesthesia to make the patient more comfortable. He then uses CPT code 00170 to bill for this service.
Anesthesia Administration for Benign Tumor Removal
A variety of non-cancerous growths can occur in a patient’s mouth. While most of these are asymptomatic, they can cause discomfort and make it difficult to eat or speak. So, for the final example of the 00170 CPT code, let’s assume a 51-year-old woman with a benign tumor on the inner lining of her cheek.
Due to this, she finds it challenging to open her jaw or eat food. Hence, she visits a hospital to get it removed. The procedure requires anesthesia. Therefore, a CRNA administers it under the supervision of an oral surgeon to reduce the patient’s anxiety. The billing team then reports this service with CPT code 00170.
Applicable Modifiers for CPT Code 00170
The following are some of the modifiers that may be used with this CPT code.
Modifier AA
Did an anesthesiologist personally administer anesthesia? In this scenario, use modifier AA with CPT code 00170.
Modifier QX
Did a qualified non-physician anesthetist, such as a CRNA, administer anesthesia for the intraoral procedure? If the service was performed under a provider’s supervision, append modifier QX to CPT code 00170.
Modifier QZ
On the other hand, if a CRNA performed anesthesia without a provider’s supervision, apply modifier QZ to CPT code 00170.
CPT Code 00170 – Billing & Reimbursement Guidelines
Here is what you can do to bill code 00170 correctly:
Ensure Correct Use of CPT Code 00170
As we said earlier, CPT code 00170 covers anesthesia for a patient undergoing an intraoral procedure. Therefore, avoid using it to bill for other procedures’ pain relief service. Additionally, do not request a separate reimbursement for this service if you are also performing the intraoral procedure.
Document the Service to Justify Medical Necessity
You must maintain a complete record for CPT code 00170 to avoid denials. The documentation for this service begins with the start and stop times. It also includes the following details:
- Pre-anesthesia evaluation
- Clinical reason (e.g., procedure complexity, patient’s condition)
- Appropriate ICD-10 code to support medical necessity
- Anesthesia type (local or general)
- Anesthesia provider’s qualification (anesthesiologist or CRNA)
- Provider’s signature
Use the Appropriate Modifiers
Payers require comprehensive information about anesthesia services, including details about the provider who administered them. Therefore, use the correct modifiers (AA, QX, or QZ) with CPT code 00170 to clearly specify this information on your claim.
Verify Payer-Specific Requirements
Remember that dental insurers usually don’t reimburse CPT code 00170. Therefore, if a patient has both medical and dental insurance plans, make sure to submit the claim for this service to the former.
Additionally, verify specific coverage details, such as pre-authorization requirements. Some payers may require you to obtain prior approval for anesthesia services, especially for patients under 20 years old.
Summary
CPT code 00170 has a straightforward description. The confusion arises with the bundling rules and varied payer requirements. Remember that payers reimburse this code only if a separate specialist has administered anesthesia before an intraoral procedure. With that, we hope that this blog has answered all your questions.
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