Anesthesia Coding Alert

Question: The anesthesiologist in our physician group states that there is a start up fee that is listed, and that we should use five extra time units for a procedure. Is this true? I have found no documentation to verify this.

Mary Holbert-Cossell
Indianapolis Neurosurgical Group, Indianapolis

Answer: The start up fee is a base value. Every surgery performed has an innate base value that is dictated by the complexity of the surgery (i.e., surgery performed on the feet, toes, hands and fingers are 3-base procedures, whereas coronary artery bypass grafts [CAGB] and other heart procedures have a 20-base value). Time is usually added on at one unit for every 15 minutes (although some carriers may use 10-minute increments instead).

For example, code 64721 (neuroplasty and/or transposition; median nerve at carpal tunnel), where the patient is anesthetized for one hour would be charged as 3 base units, and 4 time units for the hour, for a total of 7 units to be charged. A CAGB (using code 33512, coronary artery bypass, vein only; three coronary venous grafts) with the patient sedated for five hours would be charged as 20 base units for code 33512 and 20 time units for the five hours, for a total charge of 40 units. These examples assume that the carrier has 15-minute time units; check with your local carrier to see if you should be using other increments instead.