Section title: Requests for Interpretation
RFI #
2363
Anesthesia Add-On HCPCS 01953
Description

I am inquiring about anesthesia Add-On HCPCS 01953 and the type of unit required. The workgroup considers codes in the Anesthesia section (currently 00100 to 01999) to be anesthesia procedures. Per the TR3, all anesthesia HCPCS should be billed using MJ as the units:

REQUIRED SV103 355 Unit or Basis for Measurement Code X 1 ID 2/2
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
SYNTAX: P0304
CODE DEFINITION
MJ Minutes
845 Required for Anesthesia claims.

There has been an exception to HCPCS 01996 but I am wondering if HCPCS 01953 has this exception as well or if the TR3 requirement of reporting anesthesia codes with MJ applies to this add on code as well.

Response

It is not within X12's purview to provide billing directions. The intent of the instructions in version 005010 is for the provider to follow the directions for use of the applicable code set from the maintainers of those code sets and any additional supporting documentation referred to by the maintainer. The appropriate qualifier should be used based on the code set maintainer's instructions for billing that code.  

RFI Recommendation

Version 007030 has added verbiage to clarify the use of these data elements. The 007030 version will be open for public comment again in the near future.  Participating in the public comment period will help ensure that the added notes meet the business need.

DOCUMENT ID
005010X222