Anesthesia Coding Alert

Question: Can you explain discontinuous time? I am asking because we have two sets of times. We have pre-op time where the anesthesiologist prepares the patient, and then we have the actual time in the operating room. We have been told by our compliance department that we should not expect to combine these times for billing because it is not continuous time.

Maryland Subscriber

Answer: Preoperative time and discontinuous time are two separate concepts, so you need to be careful to understand the difference.

Remembering that preoperative time is not separately billable is important, as it is included in the base value for all anesthesia services.

The American Society of Anesthesiologists (ASA) updated their definition of anesthesia time in 2019. The 2019 update can help you understand both when anesthesia time begins and how to handle interruptions in anesthesia time.

To show the difference, both the 2018 and 2019 definitions from the ASA Relative Value Guide^® are below, as reported at www.asahq.org/quality-and-practice-management/ managing-your-practice/timely-topics-in-payment-and-practice-management/2019-relative-value-guide-updates-include-anesthesia-time-and-field-avoidance.

2018 RVGTM: “Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia care in the operating room or in an equivalent area, and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient is safely placed under post-anesthesia supervision.”

Note that the 2018 ASA definition matched the CPT^® Anesthesia section guidelines (still current in 2022) almost word for word: “Anesthesia time begins when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room (or in an equivalent area) and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision.”

2019 RVGTM: “Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is, when the patient is safely placed under postoperative care. Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time for services furnished, the anesthesia practitioner can add blocks of time around an interruption in anesthesia time as long as the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption” (bold added for emphasis).

According to the updated definition, anesthesia time is a continuous period, although you may add blocks of time if there is an interruption in anesthesia time.

The general rule is to add the blocks of time together and report the total minutes as the documented anesthesia time. The information must be clear on the anesthesia record. 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.