Knowing and following the rules and guidelines specific to anesthesia care is necessary to accurately report anesthesia services. Anesthesiology medical billing can be complex, which is why most providers now rely on an experienced medical billing company to report procedures, prevent denials, and maximize reimbursement. Here are 5 tips to optimize anesthesia medical billing.
- Report time correctly: Anesthesia medical billing involves calculating time units and base units. Base units are the numeric value that CMS has attached to the anesthesia CPT codes for anesthesia services. Time units are determined using the total time in minutes actually spent performing the procedure. One time unit constitutes fifteen minutes. Correctly documenting start and stop times is crucial for proper billing. Start time is when the anesthesia practitioner begins to physically prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the practitioner is no longer in constant attendance and the patient may safely be placed under postoperative supervision. CMS and commercial insurance companies have rules for calculating time units. For instance, in accordance with CMS guidelines, UnitedHealthcare requires time-based anesthesia services be reported with actual Anesthesia Time in one-minute increments — if the Anesthesia Time is one hour, then 60 minutes should be submitted (www.uhcprovider.com). Billing specialists in anesthesiology medical billing companies are knowledgeable about the calculation of base units and the use of conversion rates for total anesthesia time.
- For multiple procedures, bill the procedure with the highest base value: An article by www.ciproms.com explains that some ASA codes include multiple areas in their description and have higher base units. When working in multiple areas of the spine and abdomen, an anesthesiologists can avoid under-billing their services by using codes with higher base units.
- Know the modifiers to report: Claims for procedures and services should be submitted with accurate CPT codes and modifiers. Appending modifiers provides additional information related to the procedure code. According to the American Association of Anesthesiologists (ASA), every anesthesia claim billed to Medicare and many other payers should have one of the following modifiers:
AA Anesthesia Services performed personally by the anesthesiologist
AD Medical Supervision by a physician: more than 4 concurrent anesthesia procedures
QK Medical Direction of two, three or four concurrent anesthesia procedures involving qualified individuals
QX Qualified non physician anesthetist service: With medical direction by a physician
QY Medical direction of one qualified non physician anesthetist by an anesthesiologist
QZ CRNA service: Without medical direction by a physician
Additionally, the ASA points out that payers may require the following HCPCS modifiers for monitored anesthesia care (MAC):
QS Monitored anesthesia care service
G8 Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedures
G9 Monitored anesthesia care for patient who has a history of server cardio-pulmonary condition
- Report the right codes: Reporting the right CPT and HCPCS codes and modifiers provides information about the service and how it was performed. ICD-10 codes show why a service was performed, that is, they establish medical necessity and also determine if circumstances in which the service was provided is in accordance with the payer’s coverage policies. ICD-10 codes change when the fiscal year begins on October 1, while CPT code updates take effect with the start of the calendar year. Medical billing and coding service providers need to stay up-to-date on annual coding changes.
- Report qualifying circumstances: Reporting of qualifying circumstances leads to improved payment, better clinical documentation, and improved compliance. Qualifying circumstances denote conditions that significantly impact the nature of the anesthetic service provided. An AAPC article provided the following example of reporting qualifying circumstances: A 3-month-old female undergoes hernia repair. An add-on code will allow the additional 1 unit of anesthesia to the base units and ensure proper reimbursement:
+99116 Anesthesia complicated by utilization of total body hypothermia (List separately in addition to code for primary anesthesia procedure)
Not documenting qualifying circumstances can lead to significant loss of revenue.
The best way to ensure proper compliance and maximize reimbursement revenue is to partner with an experienced anesthesiology medical billing service provider. This will reduce risks of claim denial and delays and relieve your in-house staff of the hassles of billing anesthesia services.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.