Is there any classes I can take to learn the right way of billing for Anesthesia claims? I just started doing the billing for the Anes side of our facility and don't think something is right. We are billing for the base units, time, risk factor but only getting paid for the time due to that is what is being sent to the insurance. I'm being told we can only bill the insurance either the time or units not both. Also we are being told that we need to bill the anes code for the time and the procedure code that was done for the other is that true too? I really need a class on Anes billing.
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Wiki Anesthesia Billing
- Thread starter dawnha1
- Start date
Jejohnson
Guest
I believe there is a specialty course available and I want to say something else. Let me check my events and get back to you.
lexvcarter
Guest
Don't waste your money on an anesthesia class. It's really simply & I'm more than happy to assist.
Each surgery CPT code has an anesthesia code associated to it (besides add on code). Your EMR system should automatically convert the primary surgery code once you create the particular anesthesia claim. To learn more about the crosswalk, RVU's and methodology I attached two documents below. I'm still looking for a CPT Anesthesia to Procedure Code Crosswalk list with the base units. That way you won't have to use the formula. Ok, here we go!
Coding & Billing Anesthesia
1. Modifiers
Resource: http://www.anesthesiabilling.org/search/label/Terms and Definition
Each surgery CPT code has an anesthesia code associated to it (besides add on code). Your EMR system should automatically convert the primary surgery code once you create the particular anesthesia claim. To learn more about the crosswalk, RVU's and methodology I attached two documents below. I'm still looking for a CPT Anesthesia to Procedure Code Crosswalk list with the base units. That way you won't have to use the formula. Ok, here we go!
Coding & Billing Anesthesia
1. Modifiers
M1 - Monitored Cnesthesia Care (MAC)
- Performed by Anesthesiologist
- AA = anesthesia services personally performed by the anesthesiologist
- AD = supervision, more than four procedures
- QK = medical direction of two, three or four concurrent anesthesia procedures
- QY = medical direction of one CRNA by an anesthesiologist
- Performed by CRNA (Certified Registered Nurse Anesthetists)
- QX = CRNA with medical direction by a physician
- QZ = CRNA without medical direction by a physician
M2 - ASA Status (patients physical status) *additional units*
- P1 = add 0 units to base unit
- P2 = add 0 units to base unit
- P3 = add 1 unit to base unit
- P4 = add 2 units to base unit
- P5 = add 3 units to base unit
- P6 = add 0 units to base unit
- Step 1: input the appointment facility, rendering provider, date of service and patient. If completing this on the EMR system, make sure you check the box next to "Anesthesia Claim."
- Step 2: after creating the claim you'll then input all ICD-10 codes used for the patients surgery.
- Step 3: next determine the primary surgery code & add code to claim. If the surgery required multiple CPT codes select the anesthesia code that has the highest base units value. *remember, if you're not submitting this in the EMR then refer to the anesthesia CPT code sheet.*
- Step 4: review the patients anesthesia record sheet that the anesthesiologist or CRNA filled out/signed.
- Step 5: now you'll add the first modifier under the M1 column on the claim. Determine the appropriate modifier by reviewing the monitored anesthesia care (MAC) on the record sheet.
- Step 6: next add the second modifier under the M2 column on the claim. Select the correct modifier by looking for the ASA Status on the record sheet (P1, P2, P3 or P4).
- Step 7: enter the start & end time of the anesthesia. *the time will most likely be in military time but don't worry it's intelligible*
- Step 8: insert correct base unit that is assigned to that anesthesia code AND check if any additional units are necessary. *if need be refer back to the ASA Status modifier guidelines*
Resource: http://www.anesthesiabilling.org/search/label/Terms and Definition
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