Anesthesia Coding Alert
Pass the Halfway Mark Before Billing Another Unit
Question: I understand that anesthesia minutes are calculated by 15-minute increments. Do you automatically round up to the next unit if it is 1 minute over the 15 minute increment?
Caveat: Private payers might have different rules regarding time unit calculation. For example, Blue Cross states, “Anesthesia time should be submitted on the claim as total minutes. For example, 1 hour and 9 minutes of anesthesia time is billed as 69 minutes. Then converts minutes into 15-minute increments. If a fraction is left over (less than 15 minutes), this amount will be rounded up to the next 15 minute increment or to the nearest tenth time unit.”
Idaho Subscriber
Answer: According to CMS, you must be 1 minute over the halfway point of time unit before you can report an additional unit. So, the anesthesia time needs to last 8 minutes beyond the first 15-minute increment to bill another time unit.
Rule: Chapter 12, Section G, of the CMS manual states, “Actual anesthesia time in minutes is reported on the claim. For anesthesia services furnished on or after January 1, 1994, the A/B MAC computes time units by dividing reported anesthesia time by 15 minutes. Round the time unit to one decimal place. The A/B MAC does not recognize time units for CPT® codes 01995 or 01996.”
Anesthesia Coding Alert
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