G. Anesthesia Service Included in the Surgical Procedure
Under the CMS Anesthesia Rules, with limited exceptions, Medicare does not allow separate payment for anesthesia services performed by the physician who also furnishes the medical or surgical service. In this case, payment for the anesthesia service is included in the payment for the medical or surgical procedure. For example, separate payment is not allowed for the physician's performance of local, regional, or most other anesthesia including nerve blocks if the physician also performs the medical or surgical procedure. However, Medicare allows separate reporting for moderate conscious sedation services (CPT codes 99143-99145) when provided by same physician performing a medical or surgical procedure except for those procedures listed in Appendix G of the CPT Manual.
CPT codes describing anesthesia services (00100-01999) or services that are bundled into anesthesia should not be reported in addition to the surgical or medical procedure requiring the anesthesia services if performed by the same physician. Examples of improperly reported services that are bundled into the anesthesia service when anesthesia is provided by the physician performing the medical or surgical procedure include introduction of needle or intracatheter into a vein (CPT code 36000), venipuncture (CPT code 36410), intravenous infusion/injection (CPT codes 96360-96368, 96374-96376) or cardiac assessment (e.g., CPT codes 93000-93010, 93040-93042). However, if these services are not related to the delivery of an anesthetic agent, or are not an inherent component of the procedure or global service, they may be reported separately.
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29888 KNEE ARTHROSCOPY/SURGERY M Total Facility RVU: 29.13
01400 ANESTH KNEE JOINT SURGERY M Total Facility RVU: 0.00
Code 01400 is a component of Column 1 code 29888 and cannot be billed using any modifier.
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Another thing to consider is the carrier is taking NCCI edits and using them but not making the appropriate exclusions as Medicare follows. I would appeal in writing stating, that you are aware of the NCCI code pair of 29888 and 01400 with modifier not allowed. But this applies only to the surgeon performing the surgical procedure. The anesthesia provider should be allowed separate payment because they are not performing the surgical service nor are they being paid for the surgical service. I would quote the amount time the procedure took and state that the anesthesia provider spent the allotted time providing anesthesia so the patient could have ACL repair and that this should be covered under their plan.
