Anesthesia Coding Alert

5010 standards lead to universal time reporting rules effective Jan. 1.

While all physicians will be affected when the 5010 claims form goes into effect, the transition brings one monumental change specific to anesthesia providers. Beginning Jan. 1, 2012, the new standards for electronic claims submission will require you to report all anesthesia time in minutes instead of units. Read on for advice on how to ramp up fast and keep payment flowing.

Background: For years, anesthesia providers have been able to choose whether to calculate the time for their services based on actual minutes or time units (one time unit could equal 8, 10, or 15 minutes, depending on the payer). Having this flexibility could play to the anesthesia provider's advantage when the number of minutes rounded calculations to the next full time unit. Once the provider reaches 8 minutes into a new 15-minute time unit, many payers will allow the provider to round up to the next number of time units.

Example 1: You're coding a case based on 15-minute time units. The anesthesiologist documents 17 minutes for the start-to-finish time, which calculates as 1 time unit. If he documents 24 minutes of total time, however, you could round up to 2 time units and receive additional pay.

Example 2: You're coding anesthesia for the same case, but are calculating time based on minutes instead of units. 17 minutes of time equals 1.1 unit, and 24 minutes of time equals 1.6 units. Your provider would still get paid more for the longer time, but the fee would be less than if he could charge for 2 full units.

"Documentation will be key," says Catherine Brink, BS, CMM, CPC, CMSCS, president of Healthcare Resource Management, Inc., in Spring Lake, N.J. "Of course, that means physicians need to be certain of calculating minutes instead of units."

"Change is always hard," Brink adds. "Suggest education for your physicians now on documenting cases by minutes, not units."

According to information on the American Society of Anesthesiologists' website, "This change may result in some payers attempting to move from a full unit to a fractional unit payment system. A move from a full unit to a fractional unit system would likely benefit some and cost other anesthesia providers depending on when the individual contracts permit rounding to the next unit."

Positive: Because providers negotiate their contracts with private payers, you still might be able to submit those claims based on rounded time units instead of minutes. Address the issue during contract negotiations to reach an agreement between your physician and the payer.