Anesthesia Coding Alert
Puzzle Out Proper Reporting for Partially Covered Cases
Question: We have a patient who underwent a procedure — part of the service is covered by insurance, but the other part of the case isn’t because it’s cosmetic. Is it possible to bill the payer a portion of the anesthesia service and have the other portion billed to the patient? If so, are we required to reduce the base value? Arizona Subscriber Answer: Yes, it is possible. Your anesthesia provider must differentiate between the anesthesia time for the insurance-covered portion and the anesthesia time for the cosmetic portion of the procedure in the documentation to enable proper reporting. Covered portion: Only report the insurance-covered part of the service, including time, base value, and any applicable qualifying circumstances, to the payer. Do not reduce the base value. Cosmetic portion: You will typically bill this part using a flat rate based on the length of time the surgeon estimates they will spend on the cosmetic portion and collect payment before the surgery. If this patient is post-op and has already received anesthesia, bill the cosmetic portion directly to the patient. For future services, you should work with the surgeon’s office to collect payment in advance for the cosmetic portion.
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