Anesthesia Coding Alert

Bust these myths to boost your chances of anesthesia claims success.

Anesthesia coding tends to be more challenging than other specialties because of the many factors that add complexity. That’s why it’s beneficial to periodically refresh your understanding of the basics like calculating time and anesthesia charges. Otherwise, you risk miscalculations, which can result in denied or rejected claims and lost revenue.

Sharpen your time calculation skills by busting these five myths surrounding calculating total time for anesthesia services to be sure you’re reporting — or not reporting — time units correctly, depending on the situation.

Myth 1: Use 15 Minutes = 1 Time Unit, Regardless of Payer

Reality: 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 8, 12, or some other time increment as defined by either an existing contract or their own policies. “Your best bet is to speak with your individual payer to confirm their guidelines,” says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPMA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida.

Myth 2: Add Pre-Op and Intra-Op Times To Get Total Time

Reality: You cannot include the pre-op exam in the anesthesia time. An anesthesia history and physical (H&P) is required for every patient, so it is included in the base unit value used to calculate payment for the anesthesia code, according to Medicare’s National Correct Coding Initiative (NCCI) Policy Manual, Chapter II.B.3. Therefore, you cannot charge separately for the routine pre-op examination.

Both CPT^® Anesthesia section guidelines and the NCCI manual agree that anesthesia time starts when the anesthesia practitioner begins to prepare the patient for anesthesia in the operating room or equivalent area. Anesthesia time ends when the patient is placed safely under postoperative care. CPT^® guidelines word this as “the anesthesiologist is no longer in personal attendance.” The NCCI manual describes it as “the anesthesia practitioner is no longer furnishing anesthesia services to the patient.”

Myth 3: Don’t Add Blocks of Discontinuous Time

Reality: Anesthesia time is a continuous period, although you may add blocks of time if there is an interruption in care during a procedure, marked by when the anesthesiologist is no longer personally attending to the patient. Providers must record the exact time(s) care was interrupted to accurately report discontinuous time.

The general rule is to add the blocks of time together and report the total minutes as the documented anesthesia time — then convert the total minutes to time units. Some software systems can accommodate discontinuous time for reporting purposes. If not, you will need to update the time manually to report discontinuous time to your insurance carriers.

Let’s say the anesthesiologist begins care at 08:00; care is interrupted at 08:24 and resumes at 08:36; anesthesia end time is 09:04. The anesthesia start time is when the physician administers the medications (8:00), and the stop time is when the anesthesiologist leaves the patient (8:36). No time should be billed for the 11-minute delay. The second anesthesia start time is when the case resumes (8:36), and the second anesthesia stop time is when the patient is safely transferred to the post-anesthesia care unit (9:04). So, for this case, total anesthesia time is 52 minutes ÷ 15 minutes = 3.47 time units, “which is typically rounded up to 4 units for billing purposes, and payment depends on the insurance,” Dennis notes. “For example, Medicare pays exact time and will process at either 3.4 or 3.5 units, depending on the Medicare Administrative Contractor,” she adds.

Tip: If your system doesn’t accommodate reporting discontinuous time, you may manually override the start or stop time and make a note to explain a potential concurrency report error.

Myth 4: Always Count Time for Flat-Fee Services

Reality: While you are required to list times when you bill out anesthesia codes (00100- 01999), you don’t need to submit time on a claim for flat-fee services such as:

• Epidural steroid injection (ESI) – i.e., 62323 (Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution … lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT))
• Moderate sedation — i.e., 99152 (Moderate sedation services provided by the same physician … performing the diagnostic or therapeutic service that the sedation supports … initial 15 minutes of intraservice time, patient age 5 years or older)

Tip: You’ll still need documentation supporting the interservice time for moderate sedation, which must be at least 10 minutes.

Myth 5: Round Anesthesia Time to Nearest 5-Minute Increment

Reality: Your anesthesia providers should be documenting exact minutes, not rounding anesthesia time to the nearest five-minute increment. Let your anesthesiologists know that estimating the time or rounding up or down is inappropriate. Being exact is a must, as Medicare pays to one-tenth of a unit. Let’s practice time calculation and anesthesia coding with the following scenario.

Case: The physician provided anesthesia during an exploration of the pericardial sac; they did not use a pump oxygenator. Anesthesia began at 09:00 and ended at promptly 10:15. The anesthesiologist classified the patient as having severe systemic disease (P3) due to severe hypertension and diabetes mellitus.

As with any anesthesia procedure, start by calculating your time units and adding those to the base units for the anesthesia code. In this 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. Assuming your payer uses 15-minute increments, then 75 minutes equals 5 time units.

Coding tip: Medicare will not allow extra payment for modifier P3 (A patient with severe systemic disease). But you can report P3 for a non-Medicare patient, which will add one more unit to the claim because of the increased risk of putting the patient under anesthesia.

In this case, if you’re billing Medicare, you’d calculate the total units as follows: 5 time units + 15 procedure base units = 20 total units of billable anesthesia. For payers that allow the P3 modifier, add 1 unit, which equals 21 total units of billable anesthesia. Now that you have found your total units, you can calculate your expected reimbursement. Multiply the total units (20 or 21, depending on the payer) times your practice conversion factor to obtain the final charge.

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