Anesthesia Coding Alert
Get a Refresher on Medicare's Reimbursement Formula
Question: I’m new to coding and am trying to see if our Medicare reimbursement is correct, but am having trouble coming up with the correct formula for my anesthesiologist. Is it time units (1 unit = 15 minutes) + base units (as given by CMS) x the conversion factor? Alabama Subscriber Answer: Yes, your formula is correct for an anesthesia provider. Just remember that for Medicare, you report the total number of minutes on the claim form rather than dividing minutes into time units. Medicare/CMS will convert the minutes you report to units and apply the reimbursement formula. If you are trying to validate Medicare reimbursement, know that Medicare calculates units to 1/10 of a unit and does not “round” to the next whole unit. Also note: Other payers might have different reporting requirements and might calculate the units differently. For example, some payers allow you to recoup extra units for qualifying circumstances (represented by anesthesia codes 99100-99140), physical status modifiers (P1-P6), special positioning, and field avoidance. Medicare does not allow extra units in any of these situations.
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