# Tiva



## jgossett (Oct 11, 2013)

All of my online research tells me that TIVA is considered General Anesthesia when it comes to coding and billing.  Am I wrong and if so, why?  Also, is this something that is payer specific?


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## twizzle (Oct 11, 2013)

jgossett said:


> All of my online research tells me that TIVA is considered General Anesthesia when it comes to coding and billing.  Am I wrong and if so, why?  Also, is this something that is payer specific?



You are correct. TIVA is considered general anesthesia. Our CRNA's now use it for all endoscopies and payment doesn't seem to be a problem regardless of payer.


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## jgossett (Oct 16, 2013)

Thanks for your response and I was able to convince others here that TIVA is general anesthesia.  We are having payers denying the claims saying that physicians performing endoscopy and colonoscopy procedures are also able to provide any type of anesthesia unless one of the "significant diagnoses" are provided to support the need for a seperate anesthesia provider.  Doesn't matter the type of delivery.


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## strader (Nov 19, 2013)

*TIVA is General Anesthesia*



jgossett said:


> Thanks for your response and I was able to convince others here that TIVA is general anesthesia.  We are having payers denying the claims saying that physicians performing endoscopy and colonoscopy procedures are also able to provide any type of anesthesia unless one of the "significant diagnoses" are provided to support the need for a seperate anesthesia provider.  Doesn't matter the type of delivery.



Are the denials because Moderate Conscious Sedation is included in 45378 & 43239 (for example)?  If so, are they saying that if you bill with diagnosis from L32628 you can be reimbursed for TIVA (ie 00740 QZ - performed by CRNA).  Does anyone have an LCD or NCD?  L32628 applies to Monitored Anesthesia Services and does allow billing for MAC for EGD for which we bill QZ modifier.   Since TIVA is general anesthesia, I don't find an LCD that says the Physical Status conditions will be allowed for 00740QZ.  Is there a TIVA bulletin I missed?


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## missyah20 (Dec 22, 2013)

Hello There - 

I have come across certain payers whose policies are not dependent on the type of anesthesia used for gastrointestinal endoscopic procedures.  For these it doesn't matter if you are administering a MAC, TIVA, or General - you will have to meet their medical necessity requirements to receive payment for a separate anesthesia providers services. Always check the payers website to see if a policy exists or contact their provider customer service. 

Strader - I haven't come across an issue with Medicare paying on claims where the MD/CRNA considers the type of anesthesia a general even with a MAC policy in place.  If you are considering TIVA a General you won't be billing with a QS and you shouldn't come up against the Medicare LCD.


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