Anesthesia Coding Alert

Question: When does anesthesia time start and stop?

Virginia Subscriber

Answer: Anesthesia time starts when you assume control of the patient’s care for the procedure being performed. Typically, anesthesia time starts at the time the patient enters the operating room (OR) and you are in constant physical attendance with the patient. If you are delayed and enter the OR later than the patient, your start time begins when you enter the OR.

The American Society of Anesthesiologists (ASA) updated the definition in its 2019 Relative Value Guide. According to the ASA, “Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is, when the patient is safely placed under postoperative care. Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time for services furnished, the anesthesia practitioner can add blocks of time around an interruption in anesthesia time as long as the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption.”

Anesthesia time stops when you are no longer caring for the patient and have transferred that care to another person (i.e., the postanesthesia care unit [PACU] staff). This time is typically when you leave the patient’s bedside in PACU. Typically, anesthesia stop time is within 10-15 minutes of the surgical stop time. If this time is longer, there should be a reason cited in the record such as “extra time spent with patient managing laryngospasm.”

Remember: Pre-op and post-op visits are standard parts of anesthesia service and are included in the base units for each anesthesia code. Therefore, don’t bill for time spent talking to the patient in the pre-op area.

Exception: If your patient has a severe anxiety disorder, requires a much larger than average pre-operative sedative, and is personally escorted to the OR by you so you can monitor their status during the transport, then you could start your anesthesia time at the time you administered the sedative. Again, this should be well documented in your record and is a very rare occurrence.