HealthCare News

Changes to Oral Surgeons and Dentists Billing for Anesthesia Services

Issue: #398 DEC2017

Topic: Coding/Billing


Effective for services on or after January 1, 2018

This article supplements the guidance given in Bulletin 397, November 2017.

Blue Cross Blue Shield of North Dakota (BCBSND) is making the following changes to billing and coding for sedation services on medical claims when billed by the operating oral surgeon or dentist. Effective January 1, 2018, the following guidelines will apply only to claims processed by BCBSND for medical services:

  • Anesthesia services, such as moderate sedation and deep sedation, must be billed with the appropriate Code on Dental Procedures and Nomenclature (CDT) codes developed by the ADA for this service. Claims not meeting this requirement will be returned
    for correction.
  • Effective January 1, 2018, there are changes in coding for dental sedation services. Two new codes, D9222 and D9239, will be used for the initial 15 minutes of sedation. The previously existing sedation codes D9223 and D9243 were revised and will now be used for additional 15-minute increments. Please reference your 2018 CDT book for further guidance.
  • The CPT® anesthesia codes (00100-01999) reflect anesthesia services provided by an individual other than the surgeon. Anesthesia services (supervisory or other) billed by a surgeon or dentist when a CRNA or anesthesiologist administers the anesthesia service are not allowed.
  • The provider number of the provider administering the anesthesia is required on the medical claim (CMS-1500).

Deep Sedation/General Anesthesia

  • D9222 – Deep sedation/general anesthesia – first 15 minutes
  • D9223 – Deep sedation/general anesthesia – each subsequent 15-minute increment

Moderate Sedation

  • D9239 – Intravenous moderate (conscious) sedation/analgesia – first 15 minutes
  • D9243 – Intravenous moderate (conscious) sedation/analgesia – each subsequent 15-minute increment

To submit a claim, the provider must:

  • Submit the claim on a CMS-1500 claim form
  • Include the CDT code for each service
  • Include the tooth number in Box 19 – Additional Claims Information
  • Include appropriate ICD-10-CM diagnosis code
  • Include the billing provider’s NPI number in Box 33A

Please remember that if more than one surgical procedure is performed under anesthesia and not all procedures are allowed, the time for the anesthesia must be prorated for each service. This is required by BCBSND for claims processing.

Exception: FEP will not apply. Some self-funded groups may follow different guidelines depending on their benefit structure.

Example:

Dr. B, an oral surgeon, had a patient scheduled to have a surgical extraction of an impacted tooth. The patient came in and had the tooth removed. Dr. B administered the anesthetic agent at 10:15 a.m. and remains with the patient. The procedure is completed, and Dr. B is able to safely leave the room at 10:47 a.m.

When billing for this procedure, Dr. B would bill the following:

  • D7220 Removal of Impacted Tooth – Soft Tissue – 1 unit
  • D9239 Intravenous Moderate (Conscious) Sedation – First 15 Minutes – 1 unit
  • D9243 Intravenous Moderate (Conscious) Sedation – Each Subsequent 15 Minutes – 1 unit

The total anesthesia time was 32 minutes (10:15 a.m. to 10:47 a.m.). Using the scale provided as a part of the 2017 Reimbursement Notice, anesthesia time that meets or exceed 23 minutes, but is less than 38 minutes, = 2 billable units.