Revenue Cycle Insider

Question: I’m soon taking a job at an organization where I’ll be coding anesthesia services. Do anesthesia services ever require prior authorization from payers like procedures for many other specialties?

Tennessee Subscriber

Answer: Anesthesia services are often bundled into surgical procedures, so the offices supporting surgeons are usually responsible for obtaining and completing any necessary prior authorization paperwork. Many anesthesia practices may not receive billing information for the respective patient until just before the surgery itself, which would make obtaining a prior authorization in time for the scheduled procedure difficult, if not impossible.

Still, it’s important to have a general idea of a payer’s policies so you can double-check its coverage requirements, in case it doesn’t automatically bundle anesthesia services into surgery.

When anesthesia services are required for procedures beyond or outside of surgery, different rules may apply, especially if such services are not considered medically necessary. In those cases, talking to the payer before providing services is important to ensure coverage.

It’s also important to note that anesthesia services involved in dental procedures may have different rules and norms for prior authorizations.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC