Anesthesia Coding Alert

Question: Is the pre-op exam by the anesthesiologist counted in the time? If not, how is the anesthesiologist paid for that work?

Texas Subscriber

Answer: You should not include the pre-op exam in the anesthesiology time. The pre-op exam is standard medical practice, so it is included in the base unit value used to calculate payment for the anesthesia code, according to Medicare’s National Correct Coding Initiative (NCCI) Policy Manual, Chapter II.B.3.

Both CPT^® Anesthesia section guidelines and the NCCI manual agree that anesthesia time starts when the anesthesia practitioner begins to prepare the patient for anesthesia in the operating room or equivalent area. Anesthesia time ends when the patient is placed safely under postoperative care. CPT^® guidelines word this as “the anesthesiologist is no longer in personal attendance.” The NCCI manual describes it as “the anesthesia practitioner is no longer furnishing anesthesia services to the patient.”

Tip: The American Society of Anesthesiologists (ASA) updated their definition in 2019 to be similar to NCCI’s wording, stating anesthesia time ends “when the anesthesia practitioner is no longer furnishing anesthesia services to the patient” (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).