Scenario 1:
A 45-year-old patient with a history of hypertension requires surgery to repair a herniated disc in the lumbar region. The surgery lasted 2 hours and 45 minutes, and the patient had a qualifying circumstance of controlled hypertension. The anesthesia provider used general anesthesia.
Anesthesia codes used: 00560, 99100-QC
Calculation of base and time units:
The base unit value for anesthesia code 00560 is 5.
The time unit value for anesthesia code 00560 is 22, based on the total time of 2 hours and 45 minutes.
There are no modifying circumstances.
The conversion factor is $23.79.
Anesthesia service payment formula: (base units + time units) x conversion factor = reimbursement
Reimbursement for scenario 1: (5 + 22) x $23.79 = $644.05
Coding response: 00560, 99100-QC
Scenario 2:
A 65-year-old patient with a history of diabetes requires surgery to remove a malignant tumor in the colon. The surgery lasted 4 hours and 15 minutes, and the patient had a qualifying circumstance of controlled diabetes. The anesthesia provider used general anesthesia.
Anesthesia codes used: 00810, 99116-QC
Calculation of base and time units:
The base unit value for anesthesia code 00810 is 6.
The time unit value for anesthesia code 00810 is 26, based on the total time of 4 hours and 15 minutes.
There are no modifying circumstances.
The conversion factor is $23.79.
Anesthesia service payment formula: (base units + time units) x conversion factor = reimbursement
Reimbursement for scenario 2: (6 + 26) x $23.79 = $748.28
Coding response: 00810, 99116-QC
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