Anesthesia Coding Alert

Question: I have doubts regarding flat fee calculation. My client calculates time using 11-minute units, not the standard 15-minute units. I haven't seen any examples like this in the ASA guidelines. What should I do?

Indiana Subscriber

Answer: Flat fee services are just that -- one fee for the service. CMS processes using 15-minute units. A few companies still allow 10-minute units, but most use the CMS 15-minute-unit policy.

Fifteen-minute increments are the most commonly used with carriers such as Medicare and Medicaid. These are mandated, meaning that your client doesn't have a choice unless they don't participate in those programs.

Although some private insurance companies have followed suit and pay in 15-minute increments, your client is not required to report time in 15-minute increments unless they have a contractual agreement.

Remember: The ASA RVG (Relative Value Guide) indicates that time is calculated "as is customary in your geographical area." This is because anesthesia time-unit calculations can vary from a one-minute increment to increments of 10, 12 or 15 or more minutes. Although you always report exact time to Medicare, other carriers may round up or down. If possible, you should check your client's written contracts to determine how the contracted carriers are paying for and allowing time.