Question

CPT code modifier 47 Anesthesia by Surgeon

How modifier is used and scenario using the code.

Answer 1

Ans) Modifier -47 is used to report regional or general anesthesia provided by the attending or assistant surgeon. Add CPT modifier 47 to the basic service. This does not include local anesthesia.

- Coding Guidelines
“Medicare Anesthesia Rules prevent separate payment for anesthesia services by the same
physician performing a surgical or medical procedure. The physician performing a surgical or medical procedure should not report CPT codes 96360-96376 for the administration of anesthetic agents during the procedure. If it is medically reasonable and necessary that a separate provider (anesthesia practitioner) perform anesthesia services (e.g., monitored anesthesia care) for a surgical
or medical procedure, a separate anesthesia service may be reported by the second provider.” (CMS1)
“Under OPPS, anesthesia for a surgical procedure is an included service and is not separately reportable. For example, a provider should not report CPT codes 96360-96376 for anesthesia services.” (CMS1)
“When anesthesia services are not separately reportable, physicians and facilities should not
unbundle components of anesthesia and report them in lieu of an anesthesia code.” (CMS1)
“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.” (CMS2)
“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.” (CMS2)
The physician performing a surgical or medical procedure should not report an epidural/ subarachnoid injection (CPT codes 62310- 62319) or nerve block (CPT codes 64400-64530) for anesthesia for 62319) or nerve block (CPT codes 64400-64530) for anesthesia for that procedure.” (CMS2)
“Postoperative pain management services are generally provided by the surgeon who is reimbursed under a global payment policy related to the procedure and shall not be reported by the anesthesia practitioner unless separate, medically necessary services are required that cannot be rendered by
the surgeon. The surgeon is responsible to document in the medical record the reason care is being referred to the anesthesia practitioner.”