Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 2 - Medical Guidelines › Chapter 51 - Medical Reimbursement Schedule › Section I-5117 - Anesthesia

Current through Register Vol. 50, No. 6, June 20, 2024
A. General. The
				  total anesthesia allowance is calculated by adding the basic value units, time
				  value units, plus any applicable modifier unit values and/or unusual qualifying
				  circumstances units and multiplying the sum by a dollar amount allowed per
				  unit.
1. Basic Units. A basic unit is listed
				  for most procedures. The allowable basic units are shown in the following
				  schedule. When multiple surgical procedures are performed during the same
				  period of anesthesia, only the greater basic unit allowance of the various
				  surgical procedures will be used as the base. The basic value for each
				  procedure includes pre- and post-operative visits, administration of fluids
				  and/or blood incident to the anesthesia care and interpretation of noninvasive
				  monitoring (EKG, temperature, blood pressure, oximetry capnography and mass
				  spectrometry). When multiple surgical procedures are performed during the same
				  period of anesthesia, only the highest base unit allowance of the various
				  surgical procedures will be used.
2. Time Units. Time begins when the
				  anesthesiologist begins to prepare the patient anesthesia care in the operating
				  room or in a equivalent area. Time ends when anesthesiologist is no longer in
				  personal attendance, that is, when the patient may be safely placed under
				  postoperative supervision. The anesthesia time units will be calculated in
				  15-minute intervals, or portions thereof, equaling one time unit. In each
				  instance, five minutes or greater is considered a significant portion of a time
				  unit. No additional time units are allowed for recovery room time and
				  monitoring.
3.
a. Modifier Units. Physical status modifiers
				  are represented by the letter "P" followed by a single digit defined below.
i.
Healthy Patient
0
ii.
Patient with mild systemic disease
0
iii.
Patient with severe systemic disease
1
iv.
Patient with severe systemic disease threat to
								life
2
v.
A moribund patient who is not expected to survive
								without the operation
3
vi.
A declared brain-dead patient whose organs are
								being removed for donor purposes
0
The above six levels are consistent with the
								American Society of Anesthesiologist (ASA) ranking of patient physical status.
Example: 00100-P1
4. Qualifying circumstances warrant
				  additional value due to unusual events. The following list of CPT-4 codes and
				  the corresponding anesthesia unit values may be listed if appropriate. More
				  than one code may be necessary. The unit value listed is added to the existing
				  anesthesia base units.
CPT-4
Units
99100
Anesthesia for patient of extreme age, under one
								year and over 70
1
99116
Anesthesia complicated by utilization of total
								body hypothermia
5
99135
Anesthesia complicated by utilization of
								controlled hypotension
5
99140
Anesthesia complicated by emergency conditions
								(specify)
2
(An emergency is defined as existing when delay in
								treatment of a patient would lead to a significant increase in the threat to
								life or body part.)
5.
				  Any procedure around the head, neck or shoulder girdle requiring field
				  avoidance or any other procedure requiring a position other than supine or
				  lithotomy, has a basic value of 5.0 units regardless of any lesser value
				  assigned to such procedure. A medical report must be attached to document the
				  special unit.
6. Unlisted Service
				  or Procedure. When an unlisted service or procedure is provided, the value
				  should be substantiated "by report." These services are shown in this schedule
				  as "BR."
7. Procedures Listed
				  without Specified Unit Values. "BR" in the value column indicates that the
				  value of this service is to be determined "by report" because the service is
				  too unusual or variable to be assigned a unit value.
8. Monitored Anesthesia Care. Monitored
				  anesthesia care occurs when the attending physician requests that an
				  anesthesiologist be present during a procedure. This may be to insure
				  compliance with accepted procedures of the facility. Monitored Anesthesia Care
				  includes pre-anesthesia exam and evaluation of the patient. The
				  anesthesiologist must participate or provide medical direction for the plan of
				  care. The anesthesiologist, resident, or nurse anesthetist must be in
				  continuous physical presence and provide diagnosis and treatment of
				  emergencies. This will also include noninvasive monitoring of cardiocirculatory
				  and respiratory systems with administration of oxygen and/or intravenous
				  administration of medications. Reimbursement will be the same as if general
				  anesthesia had been administered (time units + base units).
9. More Than One Anesthesiologist. When it is
				  necessary to have a second anesthesiologist, the necessity should be
				  substantiated by report "BR." It is recommended that the second
				  anesthesiologist receive 5 base units + time units (calculation of total
				  anesthesia value).
10. Amount
				  Payable
a. The amount payable for anesthesia
				  services will be the lesser of the actual charge or $50 times the total allowed
				  units as determined by this schedule and the above guidance.
b. The total anesthesia allowance is
				  calculated by adding the basic unit value, the number of time units, plus any
				  applicable modifier and/or unusual circumstance units and multiplying the sum
				  by the $50 allowed per unit.
c.
				  When non-anesthetic procedures are performed by anesthesiologist, they should
				  use the surgical or medical code and fee established for that code. Anesthesia
				  units and conversion factors are to be used only when the primary purpose of
				  the service is to anesthetize the patient so that the surgical procedure can be
				  performed.
d. Trigger point
				  injection is considered one procedure and is reimbursed as such regardless of
				  the number of injection sites.