Anesthesia Coding Alert

Note these 3 items of interest

The hype didn't end when HIPAA kicked in last month, and some of the changes are specifically related to anesthesia. Here's the scoop on how some of the new regulations will change how you code your next claim.

Go for Units if Possible When You're Billing Time

One change HIPAA implemented in favor of anesthesiologists was the flexibility to bill anesthesia time in base units or exact minutes. You've had to report actual time (i.e., minutes or unit fractions) for most federal payers (such as Medicare and Medicaid), but may have been rounding up for time units for commercial carriers - although this is a general guideline, not a rule set in stone, says Kelly Dennis, CPC, owner of the anesthesia consulting firm Perfect Office Solutions in Leesburg, Fla.
 
Many commercial carriers require you to bill anesthesia in time units rather than minutes. These units are almost always rounded up to the next whole unit, which means the anesthesiologist gets better reimbursement. For example, if you're dealing with 15-minute time units, any procedure lasting from 16-30 minutes is considered two time units; minute 31 brings you to the third time unit. 
 
If you report actual minutes for this case instead of units, the anesthesiologist's reimbursement depends on the carrier. If your contract doesn't specify how to handle these cases, the anesthesiologist might be paid for 2 units of time rather than the three units you would have billed under the other format.
 
"I always keep up with exact minutes for all carriers," Dennis says. "I suppose this would vary by practice, but that way I don't have to guess which time increment the carrier paid."
 
Dennis adds that charging minutes versus time units shouldn't affect how you input the case information. "Most software can accommodate different time increments and minutes versus units," she says. "I only charged time in 15-minute increments to carriers that required it. All other carriers were set to bill in 10-minute increments, and the exact time was listed separately on the claim."

Forget Type of Service 07

HIPAA mandates that all carriers go by CPT, which puts an end to some carriers requiring anesthesia codes and others requiring surgical codes for anesthesia services. Now you should always report codes from CPT's anesthesia section unless the physician performed a surgical-type service (such as administering a trigger point injection, 20552, Injection[s]; single or multiple trigger point[s], one or two muscle[s]; or 20553, ... single or multiple trigger point[s], three or more muscles). Since all anesthesia codes begin with "0," the carrier will automatically know that you're reporting an anesthesia service. That means you no longer need to report the type of service code 07 (Anesthesia service) with claims anymore to give the carrier a heads-up that you're reporting anesthesia services.
 
The ASA prepared for this complete switch to CPT by streamlining its codes to match those listed in CPT-4. Just remember that even when the ASA and CPT codes match, you'll still need some of ASA's reference books because other information you need when coding (such as base values for individual codes) is available only through its publications.
 
But Dennis says that she's seen discussion on some anesthesia-related Web sites about at least one carrier that will still require surgical CPT codes from anesthesia providers. HIPAA information about the appropriate codes for anesthesia services is somewhat ambiguous, so some carriers are handling it differently until HIPAA clarifies the guidelines. These carriers maintain that allowing anesthesiologists to report surgical CPT codes makes their coding much more accurate, but not everyone thinks the surgical codes are always necessary.
 
"Although it's difficult to figure the exact nature of the surgical procedure from a '0' code, the carrier is paying the anesthesiologist to provide safe anesthesia that allows a procedure to proceed in a specific area of the body," says Scott Groudine, MD, an Albany, N.Y., anesthesiologist. "Anesthesia codes do this job adequately. These codes are always submitted with a surgical bill, and that coding defines the surgical procedure more precisely if the carrier needs more information when addressing the anesthesiologist's bill. You must report the '0' codes to meet HIPAA compliance."

CMS Puts Contingency Plan in Place

As the Oct. 16 HIPAA implementation date loomed, CMS announced a contingency plan that would allow them to accept noncompliant electronic transmissions after the deadline. Medicare was able to process HIPAA-compliant transactions before the Oct. 16 implementation date, but some other carriers were not. The contingency plan will bridge the gap until all carriers are HIPAA- compliant without interrupting their claims processing.