Oral Surgery Anesthesia Code D9243

Effective for services provided on and after February 1, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way that we calculate the allowance for oral surgery anesthesia procedure code D9243 as noted below.

To help us calculate an accurate allowance, when submitting claims for procedure code D9243, please:

• Do not submit multiple claim lines of D9243 to indicate multiple units of these services.

• Provide the total time that anesthesia was provided on the D9243 claim line.

Electronic claim submissions

When submitting anesthesia claims electronically, be sure to include the information noted in the table below.

For paper claim submissions

When submitting anesthesia claims on a CMS 1500 form, please include the anesthesia start-to-stop time in military time separated by a dash with no spaces (e.g., HH:MM - HH:MM) in the supplemental information section in Box 24 (shaded upper row).

If you have questions, please contact your Network Specialist.

Failure to follow these claim submission guidelines may result in delays in claim processing and/or inaccurate reimbursement. Horizon BCBSNJ reserves the right to adjust finalized claims that are not processed according to these guidelines.

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Since these anesthesia services are reimbursed based on time units calculated in 15-minute intervals, additional time (less than 15 minutes) will be either rounded up or down by Horizon BCBSNJ upon claim processing.

Additional time greater than eight minutes will be rounded up to the next unit. Additional time less than eight minutes will be

Time Unit Calculations

rounded down.

For example:

• 30 minutes of anesthesia is equal to two units (30=15+15)
• 38 minutes of anesthesia is rounded up to three units (38=15+15+8)
• 37 minutes of anesthesia is rounded down to two units (37=15+15+7)