Anesthesia Coding Alert

Remember every unit is critical to anesthesia claims success.

Time calculation is an integral part of successfully reporting a provider’s anesthesia services and gaining the correct reimbursement.

Starting tip: The correct way to calculate time units depends on the payer. Medicare and Medicaid require 15-minute time units. Some commercial insurers will accept 10-minute increments, but others want 15, 12, or some other time increment. We’ve never heard of a payer switching to a different time unit basis after a certain point, but that’s not to say it couldn’t ever happen. Your best bet is to speak with your individual payer representatives to confirm their guidelines. 

Read through the following scenarios from Anesthesia Coding Alert subscribers and advice from Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. to be sure you’re reporting – or not reporting – time units correctly, depending on the situation.

Scenario 1: Add Time to Anesthesia Units

Question: Our physician provided anesthesia during an exploration of the pericardial sac. He did not use the pump oxygenator. Anesthesia began at 9:00 a.m. and ended at promptly 10:15 a.m. The patient has been classified as a P3 due to severe hypertension and diabetes mellitus. How should I code this?

Answer: As with any anesthesia procedure, start by calculating your time units and add those to the base units for the anesthesia code. In your scenario, the appropriate anesthesia code is 00560 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator), which carries 15 base units. Anesthesia time lasted 75 minutes, which is 5 time units based on a 15-minute increment. Being able to report P3 (A patient with severe systemic disease) to a non-Medicare patient adds one more unit to the claim because of the increased risk of putting the patient under anesthesia.

In this case, the total units are calculated as follows: 5 time units + 15 procedure base units + 1 unit for P3 modifier = 21 total units of billable anesthesia. Now that you have found your total units, you can calculate your expected reimbursement. Multiply 21 units times your practice conversion factor to obtain the final charge.

Tip: It’s important to stay current on the conversion factor that is paid for your state. Each year, the Centers for Medicare & Medicaid Services (CMS) updates the conversion factor rate for each state based on geographic locations.

Plus: Keep in mind that Medicare will not allow extra payment for the P3 modifier. In addition, make sure your providers are not rounding anesthesia time to the nearest five-minute increment; they should be documenting exact minutes.

Scenario 2: Add Multiple Times for Starts and Stops

Question: How do we calculate anesthesia time based on multiple starts and stops? For example, the anesthesiologist started an IV and completed the patient’s history in the holding area and then administered anesthetic drugs in the operating room. Induction and the anesthetic case was delayed 45 minutes because of an emergency surgery. Do we record all these start and stop times? Do we bill for the history/physical?

Answer: Let’s hope this is an extreme example as the anesthesiologist should not leave a patient after anesthetic drugs are administered unless there is a documented reason. For your example, we’ll presume it was an extreme circumstance and a qualified nurse was monitoring the patient who is on hold. An anesthesia history and physical are required for every patient and are included in the anesthesia start-up units or base value. Therefore, you cannot charge separately for the history/physical time for any case. However, you can bill discontinuous time for both starts and stops while the anesthesiologist was face-to-face with the patient by adding minutes from each block of anesthesia time.

First, anesthesia start time is when the drugs were administered and the stop time is when the anesthesiologist left the patient. No time should be billed for the 45-minute delay. The second anesthesia start time is when the case resumed and the second anesthesia stop time is when the patient was safely transferred to the post anesthesia care unit. Show all start and stop times on the patient’s chart and convert the total minutes to time units (remember, you can only bill time units for actual time with the patient, not the time away from the patient).

Scenario 3: Don’t Count Time for Flat Fee Services

Question: When you bill out codes 99151-+99157, don’t you enter this on the professional claim of the provider who performed the service? Let’s say it was during an epidural steroid injection with the physician administering the injection while a nurse performed the moderate sedation service. We would bill code 99152 (the patient was older than five years) along with 62323 on the physician’s claim form. When you bill out codes 99151-+99157, are you required to have the time on the claim form as you are required to have the time listed with codes 00100 - 01999?

Answer: You are correct; you don’t need to submit time on a claim for services such as an epidural steroid injection (ESI) such as 62323 (Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)). You also do not need to include time units for moderate sedation codes such as 99152 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older).

Tip: You still need documentation that supports the interservice time, which must be a minimum of 10 minutes.