Complete Guide for CPT Code 00170

For an oral operation, would you like to bill the anesthesia service? Make use of CPT code 00170! Anesthesia is necessary for several intraoral operations, including dental procedures and surgical incisions. But even the most experienced specialists are confused by its classification, particularly regarding dental operations.

The typical queries? Should anesthesia be billed separately, or is it part of the procedure? Is it appropriate to file the claim with a medical or dental insurer? Above all, which modifiers are appropriate? You’re in the right place if you’re looking for solutions to these questions as well. Stay tuned as we go into great detail about the 00170 CPT code.

Table of Contents

CPT Code 00170: Overview

For head procedures, CPT code 00170 is under the anesthesia area. More precisely, it relates to the provision of pain management services during a variety of intraoral procedures, such as but not restricted to:

Biopsy
Surgical Incision
Removal of a bone-impacted wisdom tooth

Simply put, during one of these procedures, healthcare professionals, such as anaesthesiologists or Certified Registered Nurse AAnesthetists(CRNAs), use this number to note that they have given anesthesia to numb the mouth or oral cavity. The main objective? To lessen pain and anxiety while also improving the patient’s comfort.

Situations in Which CPT Code 00170 Is Useful

The situations listed below may help you if you are confused about CPT code 00170:

General Anesthesia Administration for the Removal of Impacted Wisdom Teeth

About ninety percent of Americans have at least one wisdom tooth that’s impacted, says the American Academy of Oral and Maxillofacial Surgeons. Out of those, around sixty-five percent go for surgery, yeah, removal. That needs anesthesia, no other way really.

In the first scenario, imagine a 24-year-old woman. Her lower left third molar is badly, like really, horizontally stuck. The doctor looks at her, asks about what she feels. She says her ear hurts, she gets a lot of headaches, and the back of her mouth, it all hurts. So he orders a few scans, some imaging, just to check things are right.

The dental surgeon decides the tooth has to go, surgically. The horizontal impaction is clear. So, extraction it is. An anesthesiologist comes in, sets up general anesthesia for the procedure. They handle that part and later bill it under CPT code 00170.

How to Give Anesthesia for an Oral Biopsy

With 30,000 new cases annually, oral cancer makes up around 3% of all malignancies in the United States. Its main sign? Oral ulcers. To diagnose this disease, medical professionals perform a biopsy, which necessitates the use of anesthesia.

Let’s take a 56-year-old man, has a bleeding sore in his mouth. He deals with it for three long weeks before going to the hospital. The doctor looks inside, notices he’s also struggling to speak correctly. Not a good sign. So, to rule out mouth cancer or something else, the doctor sends him to an oral surgeon. The surgeon decides to remove the sore, just to be safe.

To help the patient feel more at ease, an anaesthesiologist gives anesthesia the treatment. He then bills for this service using CPT code 00170.

Administration of Anaesthesia for the Removal of Benign Tumours

A patient’s mouth can grow a few non-cancerous lumps, which sometimes happens. Most don’t hurt, just stay quiet. But yeah, they can still mess with talking or eating. Now picture a 51 year old woman, has a benign tumor inside her cheek. That’s our last example for CPT code 00170.

Relevant Adjustments for CPT Code 00170

Some modifiers that can be used with this CPT code are shown below.

AA Modifier

Was anesthesia administered by an anaesthesiologist? Use modifier AA with CPT code 00170 in this situation.

QX Modifier

Was anesthesia or the intraoral procedure administered by a certified non-physician anesthetist, such as a CRNA? Modifier QX should be added to CPT code 00170 if the service was rendered under a provider’s supervision.

QZ Modifier

However, add modifier QZ to CPT code 00170 if a CRNA administered anesthesia without a provider’s oversight.

CPT Code 00170: Guidelines for Billing and Reimbursement

You can appropriately bill code 00170 by doing the following:

Make Sure to use CPT Code 00170 correctly

Anesthesia for a patient having an intraoral procedure is covered by CPT code 00170, as we previously said. So don’t use it to bill for pain relief services for other surgeries. Furthermore, you are also doing the intraoral operation; do not request a separate reimbursement for this service.

Record the Service to Support Medical Needs

To prevent denials, you must keep an accurate record for CPT code 00170. The start and stop times are where the documentation for this service starts. Additionally, it contains the following information:

Assessment before anesthesia.
Clinical justification (such as the patient’s health or the intricacy of the surgery).
The ICD-10 code that best supports medical needs.
Type anesthesia (general or local).
Qualifications of an anaesthesiologist or a certified registered nurse.
The signature of the provider.

Check for Payer-Specific Conditions

Keep in mind that CPT code 00170 is typically not reimbursed by dental insurers. Therefore, be careful that you submit the claim for this service to the patient’s medical insurance plan if they have both dental and medical insurance coverage.

Make Use of the Correct Modifiers

Comprehensive information concerning anesthesia services, including specifics about the clinician who provided them, is required by payers. Therefore, to make this information explicit on your claim, the appropriate modifiers (AA, QX, or QZ) with CPT code 00170.

Furthermore, confirm certain coverage information, including pre-authorization prerequisites. For anesthesia treatments, some payers may require you to get prior approval, particularly for patients under the age of twenty.

Conclusion

“CPT code 00170” has a simple description. The bundling restrictions and different payer criteria cause uncertainty. Keep in mind that this code is only reimbursed by payers if anesthesia was delivered by a different physician before an intraoral operation. We hope that all of your questions have been addressed by this blog.

Select a committed medical coder. Excellent anesthesia billing services are provided by numerous medical billing firms. Examine your alternatives and relieve yourself of your administrative responsibilities.