Anesthesia Coding Alert

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?

Alabama Subscriber

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. Being able to report P3 (A patient with severe systemic disease) 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. Multiply 21 units times your practice conversion factor to obtain the final charge.

It’s important to stay current on the conversion factor that is paid for your state. Each year, the Centers for Medicare & Medicaid Services updates the conversion factor rate for each state.

Now that you have found your total units, you can calculate your expected reimbursement. For example, using the 2015 conversion rate for the state of Alabama of $23.47 (after July 1), your total reimbursement would be $492.87 (21 billable units x $23.47).

Extra tips: 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.