Wiki Anesthesia Units-What are the commercial

[ashleymarie510]

What are the commercial and Medicare rules for coding anesthesia units?

Unit increments are 15 minutes, of course, but what above that would constitute billing another unit? For both Medicare and commercial, please.

Thanks so much!!

 

[mcnaryk]

What are the commercial and Medicare rules for coding anesthesia units?

Unit increments are 15 minutes, of course, but what above that would constitute billing another unit? For both Medicare and commercial, please.

Thanks so much!!

Are you referring to additional units for physical status modifiers and qualifying circumstances, or using a different unit value altogether (such as 1 unit - 10 minutes)?. Medicare recognizes 1 unit = 15 minutes, and most commercial payers do the same. Now, in anesthesia billing, there are opportunities to capture extra units based on the patient's health (physical status) or other special conditions (qualifying circumstances). Medicare does NOT recognize extra units for these codes/modifiers, but commercial payers sometimes do. If you don't already, I would recommend getting a current Relative Value Guide book. In it anesthesia billing is clarified, and it explains that a P3 physical status would be worth 1 extra unit, P4 = 2 extra units, and P5 = 3 extra units. Some of the qualifying circumstances codes carry an extra base unit value of 2 or 5 that can be added on. But remember: Medicare does not recognize or pay extra for these.

I hope this answers your question...

 

[ashleymarie510]

Are you referring to additional units for physical status modifiers and qualifying circumstances, or using a different unit value altogether (such as 1 unit - 10 minutes)?. Medicare recognizes 1 unit = 15 minutes, and most commercial payers do the same. Now, in anesthesia billing, there are opportunities to capture extra units based on the patient's health (physical status) or other special conditions (qualifying circumstances). Medicare does NOT recognize extra units for these codes/modifiers, but commercial payers sometimes do. If you don't already, I would recommend getting a current Relative Value Guide book. In it anesthesia billing is clarified, and it explains that a P3 physical status would be worth 1 extra unit, P4 = 2 extra units, and P5 = 3 extra units. Some of the qualifying circumstances codes carry an extra base unit value of 2 or 5 that can be added on. But remember: Medicare does not recognize or pay extra for these.

I hope this answers your question...

Thanks for responding! Nope, just basic units.

How would, say 21 minutes of anesthesia be coded? For both commercial and Medicare?

Just one unit or two?

What is the cut-off for the minutes warranting another unit being billed?

 

[mcnaryk]

Thanks for responding! Nope, just basic units.

How would, say 21 minutes of anesthesia be coded? For both commercial and Medicare?

Just one unit or two?

What is the cut-off for the minutes warranting another unit being billed?

I'm not sure where it's written, but on the CANPC prep and exam, we rounded up to the next whole unit after 7 1/2 minutes. So for 21 minutes, you would charge 1 unit of time (15 minutes with 6 minutes leftover-those 6 minutes are not billable). Every anesthesia billing software I have used follows this rule as well.

 

[aaron.lucas]

Kristina, I have a question that may also expand the original poster's knowledge as well. I know that NY No Fault Auto and WC count 1 unit every 15 minutes for the first 300 minutes (4 hours), then every 1 unit every 10 after that. Is there anyone else that does that? For some reason I thought NY got that from CMS, but I could be wrong.

 

[Michele Hannon]

Medicare rules for time

Trailblazers and NHIC report that time units for physician and CRNA services-both personally performed and medically directed are determined by dividing the actual anesthesia time by 15 minutes or fraction thereof. Since only the actual time of a fractional unit is recognized, the time unit is rounded to one decimal place. For example.........15 minutes+1.0 unit
16-17 minutes=1.1 units
18 minutes=1.2 units
19-20 minutes=1.3 units etc.
Anesthesia time must be reported in total minutes in Item 24G on the CMS-1500.

Hope this is helpful.