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Posted By Maria on 11-15-2018, 09:15:05 in Ob-Gyn
Hey Melanie,

First thing, thanks so much for all your help recently.

I would not even know where to start with out your help. :)

I know this not your area of expertise, but one of my OBs has asked me this question.

Her hubby is a dentist and is paying an anesthesiologist (flat fee) for procedures done in dental office setting (POS 11) Thus the anesthesiologist will not bill.

The dentist then wants to submit a claim for the service, under the anesthesiologist's name/numbers, and documentation, but of course, payment to the dental practice.

The majority of these services will be for Medicaid patients. (Not sure if that is important information)

I think my CPT code will be 00170 on 1500 form

I am reading about time, units, modifiers, etc...still not totally clear but making some sense.

But my worry is how does the payer know where to send the payment if the anesthesiologist is working several POS?

Claim will be under TIN of dental practice, is that what drives where the payment is sent?

Do you know if the anesthesiologist would needed to be added on to TIN of dental practice?

If you happen to know, or have any suggestions, I would certainly appreciate.

Happy Thanksgiving,

Maria

Comments (1)
Posted By Melanie Witt on 12-06-2018, 14:32:51
Access this article: https://www.aaoms.org/images/uploads/pdfs/anesthesia.pdf. For dental procedures in the dentist's office you use CDT codes (D codes), not CPT code for anesthesia and many payers include the anesthesia (local numbing is always included). As each payer policy may be different (ie, DeltaDental versus Medicaid, versus MetLife, etc) each payer policy will need to be checked for coverage rules and applicable codes and circumstances (including billing on behalf of the anesthesiologist). Also references the following which deals with general Medicaid coverage/payment for dental services with information about restrictions per State: https://www.macpac.gov/wp-content/uploads/2015/06/Medicaid-Coverage-of-Dental-Benefits-for-Adults.pdf
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