Calculating time units for anesthesia billing and coding is extremely important. A unique characteristic of anesthesia billing is the reporting of time units. Payment for anesthesia services increases with time. In addition to reporting a base unit value for an anesthesia service, the anesthesia practitioner reports anesthesia time. We shared guidelines on correctly calculating time units for all claims and reports, to ensure your claims go smoothly and are as accurate as possible.
Determining Anesthesia Billing
- As per the national Correct Coding Initiative (CCI) chapter 2 guidelines, anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient (i.e., when the patient may be placed safely under postoperative care).
- Anesthesia time is a continuous-time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time, the anesthesia practitioner can add blocks of time around an interruption in anesthesia time as long as the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption.
- It is a standard medical practice for an anesthesia practitioner to perform a patient examination and evaluation prior to surgery. This is considered part of the anesthesia service and is included in the base unit value of the anesthesia code. The evaluation and examination are not reported in the anesthesia time.
- Most insurers allow for no more than a one-time unit to prepare patients for postoperative transfer to recovery. Insurers also do not allow billing for anesthesia time while the patient is in a waiting room or holding area. Also, when in the holding area, patients usually cannot be billed for antibiotics or any blood products that are administered. This is particularly the case when those services could be performed in another part of the facility.
- If surgery is canceled, subsequent to the preoperative evaluation, payment may be allowed to the anesthesiologist for an Evaluation & Management (E&M) service and the appropriate E&M code may be reported. Note that a non-medically directed CRNA may also report an E&M code under these circumstances if permitted by state law.
- Medicare requires exact time reporting, without rounding. For example, if anesthesia starts at 12:02 and ends at 12:59, the anesthesia time reported is 57 minutes.
- There may be interruptions in care during a procedure, marked by when the provider is no longer personally attending to the patient. By recording the exact time care was interrupted, one can accurately report discontinuous time. For example, if the anesthesiologist begins care at 8:00, but has care interrupted at 8:24 and resumes care at 8:36 before ending care at 9:04, there would be 52 minutes of anesthesia time. This would translate to 3.47-time units.
- Medicare divides the 57 minutes by 15-minute increments, for a value of 3.8-time units.
- Other insurance companies may determine time units differently, for example by using ten (10), twelve (12), or fifteen (15) minute increments. Regardless of the payer, coders should not expect to see documentation with large or unexplained gaps of anesthesia time or times that always end with a ‘0’ or ‘5.’
Example for Determining Time
- A patient who undergoes a cataract extraction may require monitored anesthesia care. This may require the administration of a sedative in conjunction with a peri/retrobulbar injection for regional block anesthesia. Subsequently, an interval of 30 minutes or more may transpire during which time the patient does not require monitoring by an anesthesia practitioner.
- After this period, monitoring will commence again for the cataract extraction and ultimately the patient will be released to the surgeon’s care or to recovery. The time that may be reported would include the time for the monitoring during the block and during the procedure.
- The interval time and the recovery time are not included in the anesthesia time calculation. Also, if unusual services not bundled into the anesthesia service are required, the time spent delivering these services before anesthesia time begins or after it ends may not be included as reportable anesthesia time.
- However, if it is medically necessary for the anesthesia practitioner to continuously monitor the patient during the interval time and not perform any other service, the interval time may be included in the anesthesia time.
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