Anesthesia Coding Alert

Question: We've gotten a kick-back claim where we reported 01480 with 15 units; the insurance company underpaid. How can I prove the conversion factor (unit base + time) to support our claim and get the additional reimbursement?

Connecticut Subscriber

Answer: The allowance for anesthesia services is based on the following formula: (Time Units + Base Units) x Conversion Factor = Allowance. Here's how it all breaks down:

• Base Units= Anesthesia procedure performed has an assigned code and each code has a base unit value. Both the American Society of Anesthesiologists (ASA) Relative Value Guide (RVG^®) and the Center for Medicare and Medicaid Services (CMS) allow three (3) base units for 01480.
• Time Units= Amount of time taken for each anesthesia procedure. If the additional twelve (12) units assigned are based on the surgery exceeding two hours (time calculated in 10 minute increments) or three hours (time calculated in 15 minute increments), you should include a copy of the anesthesia record and operative report to support the length of time reported.
• Conversion Factor= Cost assigned for each unit and are specific to the location of the anesthesia provider.
• Total Anesthesia Charge= The total number of units together it is multiplied by the conversion factor and the total anesthesia charge is calculated.