Anesthesia Coding Alert

Question: When a surgery is performed in an ASC under general anesthesia, can the ASC bill facility charges for the anesthesia services if the anesthesiologist bills separately for his/her professional charges?

Colorado Subscriber

Answer: Traditionally, most anesthesia service arrangements involved simple “fee-for-service” relationships where the ASC submits medical bills for the facility fees and the anesthesia service provider submits medical bills for the professional services rendered. However, market forces necessitated the progression from traditional fee-for-service systems to “employment and/or independent contractor” systems or the more modern “joint-venture”systems.

Anesthesia provider as employee and/or independent contractor: Many ASCs now model their business relationships after the systems found in most hospitals and hire anesthesia service providers as employees and/or independent contractors. In the employment/independent contractor system, the anesthesia service provider assigns the ASC his or her rights to submit medical bills for the anesthesia services provided to the ASC, and the ASC submits the medical bills to insurance carriers under its own name or under the name of the anesthesia service provider. In exchange, the ASC pays the anesthesia service provider either a flat per-case fee, a salary, and/or a predetermined productivity-based fee.

Joint-venture systems for anesthesia services: ASCs may also consider forming or contracting with a separately formed anesthesia service entity to establish a joint-venture system wherein the anesthesia service entity is either owned by the ASC itself, owned by the individual owners of the ASC or, in certain circumstances, owned by select physicians. The joint-venture system allows the anesthesia services entity to submit medical bills for the anesthesia services provided to the ASC, while the ASC continues to bill for the facility fees.